Dermoscopy examination of petechial lesions in a patient with Dermatitis\nHerpetiformis
We report a clinical case where purpuric lesions on the hands of a patient with DH were\nexamined under dermoscopy.\nA 22 year-old Caucasian man with one and a half year history of generalized excoriated\ncutaneous lesions was admitted with intense pruritus. Numerous excoriated papules and\ncrusts were distributed on the scalp, neck, dorsum, extensor surface of the limbs, in\naddition to the lumbar and intergluteal areas. Petechial lesions on the volar aspect of\nthe digits of the hands and feet were visible (). Dermoscopy examination (DermLite Photo; 3Gen) of the volar surface of the\nfingers revealed erythematous and violaceous dots (new petechial lesions) and\nerythematous and brown dots (old petechial lesions) (). The patient's medical history included hypothyroidism. He\npresented no gastrointestinal symptoms. He was right-handed.\nThe vicinity of a purpuric lesion on the second finger of his right hand was biopsied.\nHematoxilineosin stain revealed a subepidermal vesicle with neutrophils infiltrate in\nthe dermal papillae (). Direct\nimmunofluorescence exam of the apparently normal perilesional skin revealed granular IgA\ndeposits on the upper dermis (). The\nserum level of anti-transglutaminase IgA antibodies was 18U/ml (ELISA, normal range:\nunder 10U/ml) and G6PD was normal. Dapsone 100mg per os was initiated. After 3 days,\nthere was no pruritus, and a glutenfree diet was accepted. On the 20th day of treatment,\nwe saw only residual hyperpigmentated lesions.