22 y.o. patient of North European descend complain - iren

[ArchivalUser]

22 y.o. patient of North European descend complaints of intense burning, stinging and itching around the elbows, knees, scalp, buttocks and back. Skin lesions look like small clusters of red, itchy bumps. Skin biopsy in performed. IF studies reveal a band of immunofluorescence (IgA immunocomplexes) at the tips of the dermal papilla at the dermal-epidermal junction. What is the most effective treatment?

http://www.nlm.nih.gov/medlineplus/ency/...e/2394.jpg

A. systemic corticosteroids
B. antifungal medications
C. dapson
D. acyclovir
E. amoxicillin

[ArchivalUser]

?C dermatitis herpetiformis

[ArchivalUser]

Correct answer is C.

This is dermatitis herpetiformis. Herpes virus does not cause DH, even though the name suggests that it does. The cause of DH is allergy to gluten, a protein found in wheat and some other grains. Usually allergies, likes hives and hay fever, are made by the body's IgE system. This can be treated with pills and shots. DH is different, and is an allergy of the IgA system. IgA is an antibody produced in the lining of the intestines. The rash is caused when gluten in the diet combines with IgA, and together they enter the blood stream and circulate. They eventually clog up the small blood vessels in the skin. This attracts white blood cells (neutrophils), and releases powerful chemicals called complements. They actually create the rash. There is a very effective treatment. Dapsone is a drug that will improve DH in days. Because there can be side effects, the dose of Dapsone is usually started at a small amount, and then raised up over a few weeks until all symptoms are suppressed