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Dermatitis Herpetiformis — SCE Dermatology MCQ

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ModerateBlistering DiseasesDermatitis HerpetiformisSCE Dermatology

A 35-year-old woman presents with widespread pruritic follicular papules on her trunk and proximal limbs. She has been on Dapsone for dermatitis herpetiformis and has recently started a gluten-free diet. Despite adherence to the GFD for 18 months, she still requires Dapsone. After how long on a strict GFD might she expect to be able to discontinue Dapsone?

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Correct answer: A — 2+ years (often 18 months to 3 years)

In dermatitis herpetiformis, a strict gluten-free diet (GFD) will eventually control the skin disease and allow discontinuation of Dapsone in most patients, but this takes significantly longer than for GI symptoms — typically 18 months to 3 years of strict GFD adherence. Some patients require Dapsone for even longer. The GFD addresses the underlying pathogenesis (gluten-driven IgA response) while Dapsone provides symptomatic relief by inhibiting neutrophil chemotaxis and function. Adherence to GFD should be assessed by dietetic review and anti-tissue transglutaminase antibody levels (which fall with strict GFD).

Reference: BAD 2017 DH Guidelines; Coeliac UK