<prompt> The treatment of Dermatitis herpetiformis is ?Gluten free diet with minerals and vitaminsCarbamazepineAcyclovirCoicosteroids  <response>: A. i.e. Gluten free diet with minerals and vitamins Dermatitis herpetiformis is associated with subclinical gluten sensitive enteropathy and HLA B8 halotypeQ. It presents with severely pruritic itchy papulovesicularuicarial lesions and crusted papules excoriation symmetrically distributed over extensor surfaces i.e. elbows, knees, buttocks, back, scalp posterior neck Q. On DIM, there is granular deposition of IgA autoantibodies directed against epidermal transglutaminase in papillary dermis dermal papilla and epidermal basement membrane dermo-epidermal junction. Strick gluten free diet, Atkins diet and elemental diet is treatment of choice and dapsone is drug of choiceQ. Disease Dermatitis herpetiformis Pemphigus vulgaris Bullous pemphigoid Numular Disci. Feature Eczema Age mainly Adults 20-40 yr Adults 30-60 yrQ Elderly 60 to 80 yr Q Middle age elderly Area of predeliction Symmetrically over - Asymmetrical on - Symmetrical on lower Lower extremities distribution extensor surfaces i.e. upper half of body half of body limbs mc, upper elbows, knees, buttocks, back, scalp posterior trunk limbs i.e. scalf, face, neck, axilla trunk i.e. flexural aspects of limbs extremities and trunk neck Q trunk central abdomens Q - Oral mucosa commonly involvedQ - Mucosa not involvedQ Itching pruritis Intensely pruritic itchy with a burningstinging component Mild in early cases Itching is common may persist for months Intense itching Lesion Severely pruritic Painful, mostly - Uicarialeczematous Minute vesicle papulovesicular uicarial lesions and nonpruritic, fragile, flaccid thin wall prodrome preceding 3 weeks to months fb papules enlarge to form characteristic crusted papules delicate bullae Q on a faint, dusky erythema in erythematous excoriation Q normal or erythematous base that rupture to produce extensive denudation. a figurative pattern. - Large many cm, tense, tough, dome shaped blisters that may remain intact for several days and the contents often becoming jelly like coagulated fibrin or occasionally blood stained scaling coin shaped area Q. Associated with - Gluten sensitive enteropathy absorptive defect HLA- B8DRW3DQW2 halotype Q Mn: Row MAN i.e. Row MAN absent row of tombstone appearance, mucosal involvement acantholysis - Thyroid abnormalities Nikolysky sign present mostly hypothyroid, achlorhydria, atrophic gastritis, SLE, RA, UC, myasthenia gravis and gastrointestinal NHL General health Fair Deteriorates Fair Fair Histopathology of - Subepidermal bullae - Intra epidermal - Subepidermal bullae lesion - IgA neutrophills in bullae with without acantholysis Q papillary tip papillary acantholysis Q - Subepidermal collection tip absecss - IgG C3 deposition of IgG, C3, eosinophils - Paial villous atrophy on small intestine biopsy between epidermal cells in fishnet pattern polymorphs Management Gluten free diet, TOC and dapsone DOC Q Systemic steroid, immunosuppressant and Mx of burn Systemic steroid, immunosuppressant and Mx of burn Topical steriod 