You see a 21-year-old student with a new itchy rash on theextensor surfaces of his elbows. The rash started graduallyover a few months. On further questioning, he feels tiredall the time, but has no abdominal symptoms. This is dermatitis herpetiformis Dermatitis herpetiformis (DH) is a cutaneous manifestationof coeliac disease and affects around 1 in 10 000 people. However, fewer than 10% of people with DH have signs orsymptoms of malabsorption. DH is most common inpeople aged between 15 and 40 years but it can appearal any age after weaning. The rash consists of erythematous papules and vesicles thatcan burst with scratching. Lesions arc often symmetrical,located in clusters, and on the extensor surfaces of theelbows and knees, or buttocks. Symptoms include severeitching and scratching over the affected areas.
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