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Case Reports
. 2012 Aug;58(8):843-7.

Dermatitis herpetiformis: relevance of the physical examination to diagnosis suspicion

Paulo Ricardo Criado  1 , Roberta Fachini Jardim Criado, Valeria Aoki, Walter Belda Jr, Ilana Halpern, Gilles Landman, Cidia Vasconcellos
Affiliations
Case Reports

Dermatitis herpetiformis: relevance of the physical examination to diagnosis suspicion

Paulo Ricardo Criado et al. Can Fam Physician. 2012 Aug.
No abstract available

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Figures

Figure 1
Figure 1
Clinical photographs of patient 1, a 44-year-old white man: A) Excoriated papules and crusts on the forearm and extensor surface of the elbow. B) Meticulous clinical examination showed small vesicles on the skin of the elbow. C) Purpuric lesions on the volar aspect of the fingers. D) Purpuric lesions on the volar aspect of the toes. E) Dermoscopy of a petechial lesion on the finger demonstrating violaceous globules. F) Direct immunofluorescence of a lesion on the skin of the forearm. Notice the granular deposits of immunoglobulin A–fluorescein-marked complex at the dermal-epidermal junction of the skin (papillae of dermis).
Figure 2
Figure 2
Clinical features of patient 2, a 19-year-old white woman: A) Excoriated papules and plaques on the back. B) Detail of the excoriated papules and crusts on the back. C) Papules and urticarial plaques on the buttocks and sacral area. D) Erythematous papules and urticarial lesions on the elbows. E) Excoriated papules and plaques on the submandibular area. F) Histopathologic examination of a skin lesion on the elbow showing small vesicles (hematoxylin and eosin stain, original magnification × 100). G) Detail of the subepidermal vesicle (hematoxylin and eosin stain, original magnification × 200). H) Direct immunofluorescence of a lesion on the back. Note the granular deposits of immunoglobulin A–fluorescein-marked complex at the dermal-epidermal junction of the skin (papillary dermis).
Figure 3
Figure 3
Clinical features of patient 3, a 58-year-old white man. A) Excoriated papules and crusts on the extensor surface of the elbow; B) knee; and C) buttocks. D) Histopathologic examination of a skin lesion on the dorsum of the foot showing a small subepidermal vesicle (hematoxylin and eosin stain, original magnification × 400). E) Detail of the subepidermal vesicle leading to a microabscess filled with neutrophils (hematoxylin and eosin stain, original magnification × 1000). F) Direct immunofluorescence of the back skin. Note the granular deposits of immunoglobulin A–fluorescein-marked complex at the dermal-epidermal junction of the skin (papillary dermis).
Figure 4
Figure 4
Clinical features of patient 4, a 22-year-old white man. A) Extensive excoriated papules and crusts on the back and B) legs. C) Purpuric lesions on the volar aspect of the fingers. D) Dermoscopy of petechial lesions on the finger demonstrating violaceous globules (newest lesions) and brownish dots and globules (oldest lesions). E) Excoriated papules and residual lesions on the buttocks. F) Excoriated papules and crusts on the extensor surface of the elbow. G) Direct immunofluorescence of the forearm skin. Note the granular deposits of immunoglobulin A–fluorescein-marked complex at the dermal-epidermal junction of the skin (papillary dermis).
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