Thursday, January 24, 2013

Female with papules and vesicles

Clinical Vignette: A 40-year-old female presents with a six month history of pruritic papules, vesicles and excoriations on the elbows, knees, buttocks and scalp. Her GP has prescribed topical betamethasone therapy which has been unhelpful. What is the most likely diagnosis?

  1. Atopic dermatitis (Eczema)
  2. Dermatitis herpetiformis
  3. Hennoch-Schonlein purpura
  4. Psoriasis
  5. Scabies
Answer to clinical vignette|case: (2)

The question describes the characteristic distribution of the lesions of dermatitis herpetiformis. DH is one of the immunobullous conditions and characteristically has very intensely pruritic vesicles. It is not usually responsive to topical steroids, but would respond well to dapsone. It is associated with gluten sensitivity and coeliac disease.
Atopic eczema is non vesicular and would respond to potent topical steroids.
Hennoch-Schonlein purpura is a purpuric rash and is non pruritic.
Scabies usually affect the extremities and rarely affects above the neck line. It does not cause papules and vesicles.