Case description: A 67 years old man presented to the cl inic complaining of an i tchy bl istering skin rash over
elbows, knees and but tocks for the past 2 months that is not responding to antihistamines. Itching has no diurnal
variation. Patient has no chronic comorbidi ties a nd is not on regular medications. On examination, symmet rical
vesicular lesions wi th erythema, crusting and i tch marks are seen over both elbows, knees and back wi th -ve
Ni c ol s k y ' s s i gn . G en e ral ex a mi na ti on rev eal s p al l o r, p ati ent B MI 1 7.5 , ab do mi nal di s te ntion, and peripheral
neuropathy. Investigations showed microcytic hypochromic anemia wi th HGB 9.8 mg/dl , MCV 68, HCT 29.8, WBCs
and platelets are normal . K 3.1mg/dl , Na 135 meq/dl , Ca 8.5mg/dl , albumin 3g/dl . Skin biopsy and di rect
immunofluorescence of the skin around the lesions was taken that was diagnosed as dermati tis herpeti formis.
Endoscopy was done and i t confi rmed the diagnosis of cel iac disease.Treatment: Patient was advised to fol low a
gluten f ree diet plan and dapsone was started at a dose of 1 00 mg/day. Patient rash resolved gradual ly over a
period of 3 weeks.