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Chronic Venous Insufficiency — SCE Dermatology MCQ

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HardWound HealingChronic Venous InsufficiencySCE Dermatology

A patient has intensely pruritic grouped vesicles on elbows and buttocks. Coeliac serology is positive, but lesional biopsy shows only excoriation. What specimen is most likely to confirm dermatitis herpetiformis?

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Correct answer: D — Normal-appearing perilesional skin for direct immunofluorescence demonstrating granular IgA

Explanation lettering: E = shown as A · D = shown as C · A = shown as D · C = shown as E

A is correct. Direct immunofluorescence of normal-appearing perilesional skin is the diagnostic gold standard; granular IgA is found in dermal papillae or along the dermoepidermal junction. A heavily excoriated or fully blistered lesion may lose diagnostic deposits and yield nonspecific histology. Coeliac serology supports the gluten-sensitive enteropathy association but does not replace skin immunofluorescence when the cutaneous diagnosis is uncertain. Linear IgG suggests a different autoimmune blistering disorder, while culture and Congo red do not establish dermatitis herpetiformis.

Reference: British Association of Dermatologists: dermatitis herpetiformis: https://www.bad.org.uk/pils/dermatitis-herpetiformis/