<prompt> Patient with gluten sensitive enteropathy has a lifelong background of periodic crops of intensely pruritic, grouped, papular or vesicular lesions on the elbows, knees, sacrum and shoulders. Since the vesicles are intensely pruritic, the patient regularly scratches the top off them, which relieves pruritis. What is the most probable diagnosisBullous pemphigoidDermatitis herpetiformisHerpes simplex 1Pemphigus vulgaris  <response>: Dermatitis Herpetiformis Duhrings Disease Recurrent chronic pruritic disease associated with gluten-sensitive enteropathy Gluten: general name for storage proteins found in wheat, rye, and barley NOT found in rice, oats or corn Gliadin: soluble fraction; likely antigenic component Autoantigen: epidermal transglutaminase TG-3, tissue transglutaminase endomysial Clinical features:- Erythematous grouped papules or vesicles over elbows, knees, buttocks; intensely pruritic, so primary lesions typically not visible due to excoriations Histology:- Neutrophilic microabscesses in dermal papillae, - subepidermal vesicles DIF:- Granular IgA C3 deposition in dermal papillae IIF:- negative Labs: anti-gliadinanti-endomysial antibodies in DHceliac disease Treatment:- Dapsone immediate skin improvement, referral to GI 90 with gluten-sensitive enteropathy and risk of small bowel lymphoma Incidence thyroid disease Hashimotos thyroiditis, IDDM, enteropathy-associated T cell lymphoma Associated with HLA-DQ2 strongest, HLA-B8. Ref:- Sima Jain; pg num:-132,134 