Question:medium
A patient with intensely itchy vesicular lesions on the extensor surface presents with history of gluten sensitivity. What is the likely diagnosis?
A patient with intensely itchy vesicular lesions on the extensor surface presents with history of gluten sensitivity. What is the likely diagnosis?
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Itchy grouped vesicles on extensor surfaces with gluten sensitivity = dermatitis herpetiformis.
Updated On: May 14, 2026
- Bullous pemphigoid
- Pemphigus vulgaris
- Dermatitis herpetiformis
- Psoriasis
Show Solution
The Correct Option is C
Solution and Explanation
Step 1: Understanding the Question:
The clinical association of gluten sensitivity (Celiac disease) and an intensely pruritic (itchy) vesicular rash on the extensor surfaces is highly characteristic of a specific autoimmune blistering disease.
Step 2: Detailed Explanation:
Dermatitis Herpetiformis (DH):
Association: Strongly linked to gluten-sensitive enteropathy. Almost all DH patients have some degree of gluten sensitivity.
Location: Symmetrically distributed on extensor surfaces (elbows, knees, buttocks, scalp).
Morphology: Grouped "herpetiform" vesicles on an erythematous base. Because of intense itching, the vesicles are often excoriated and only crusts are seen.
Immunopathology: Characterized by granular IgA deposits in the dermal papillae on direct immunofluorescence (DIF).
Analyzing other options:
Pemphigus Vulgaris (B): Presents with flaccid blisters and mucosal involvement; not related to gluten.
Bullous Pemphigoid (A): Presents with tense blisters in elderly patients; not related to gluten.
Step 3: Final Answer:
The history of gluten sensitivity combined with itchy vesicles on extensors is the classic presentation of Dermatitis herpetiformis.
The clinical association of gluten sensitivity (Celiac disease) and an intensely pruritic (itchy) vesicular rash on the extensor surfaces is highly characteristic of a specific autoimmune blistering disease.
Step 2: Detailed Explanation:
Dermatitis Herpetiformis (DH):
Association: Strongly linked to gluten-sensitive enteropathy. Almost all DH patients have some degree of gluten sensitivity.
Location: Symmetrically distributed on extensor surfaces (elbows, knees, buttocks, scalp).
Morphology: Grouped "herpetiform" vesicles on an erythematous base. Because of intense itching, the vesicles are often excoriated and only crusts are seen.
Immunopathology: Characterized by granular IgA deposits in the dermal papillae on direct immunofluorescence (DIF).
Analyzing other options:
Pemphigus Vulgaris (B): Presents with flaccid blisters and mucosal involvement; not related to gluten.
Bullous Pemphigoid (A): Presents with tense blisters in elderly patients; not related to gluten.
Step 3: Final Answer:
The history of gluten sensitivity combined with itchy vesicles on extensors is the classic presentation of Dermatitis herpetiformis.
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