Approach to the Patient with Suspected Dermatitis Herpetiformis - Flowchart
Approach to the Patient with Suspected Dermatitis Herpetiformis - Flowchart Dermatitis Herpetiformis Dermatitis Herpetiformis
«Flowchart»

Patient with clinical findings of DH

Patient with clinical findings of DH

Patient with clinical findings of DH

Patient with clinical findings of DH


Treat per biopsy results
Monitor clinically


Treat per biopsy results
Monitor clinically


Treat per biopsy results
Monitor clinically


Treat per biopsy results
Monitor clinically

Serologic analysis


Total IgA level
Anti-tTG IgA, IgG
Anti-eTG (if available) IgA, IgG
Anti-endomysial IgA, IgG

Serologic analysis


Total IgA level
Anti-tTG IgA, IgG
Anti-eTG (if available) IgA, IgG
Anti-endomysial IgA, IgG

Serologic analysis

Serologic analysis


Total IgA level
Anti-tTG IgA, IgG
Anti-eTG (if available) IgA, IgG
Anti-endomysial IgA, IgG


Total IgA level
Anti-tTG IgA, IgG
Anti-eTG (if available) IgA, IgG
Anti-endomysial IgA, IgG

Serologic analysis


Total IgA level
Anti-tTG IgA, IgG
Anti-eTG (if available) IgA, IgG
Anti-endomysial IgA, IgG

Serologic analysis


Total IgA level
Anti-tTG IgA, IgG
Anti-eTG (if available) IgA, IgG
Anti-endomysial IgA, IgG

Serologic analysis

Serologic analysis


Total IgA level
Anti-tTG IgA, IgG
Anti-eTG (if available) IgA, IgG
Anti-endomysial IgA, IgG


Total IgA level
Anti-tTG IgA, IgG
Anti-eTG (if available) IgA, IgG
Anti-endomysial IgA, IgG

Biopsies


Lesional punch biopsy for H&E
Perilesional punch biopsy for DIF

Biopsies


Lesional punch biopsy for H&E
Perilesional punch biopsy for DIF

Biopsies

Biopsies


Lesional punch biopsy for H&E
Perilesional punch biopsy for DIF


Lesional punch biopsy for H&E
Perilesional punch biopsy for DIF

Findings consistent with another dermatosis, not DH

Findings consistent with another dermatosis, not DH

Findings consistent with another dermatosis, not DH Findings consistent

Findings consistent with DH

Findings consistent with DH

Findings consistent with DH Findings consistent with DH

Equivocal

Equivocal

Equivocal Equivocal

End

End

End

Screening for associated disease


Thyroid function testing
Anti-thyroid peroxidase testing
Blood glucose screen
Other autoimmune serologic tests based on physical exam findings
If long-standing, blood smear

Screening for associated disease


Thyroid function testing
Anti-thyroid peroxidase testing
Blood glucose screen
Other autoimmune serologic tests based on physical exam findings
If long-standing, blood smear

Screening for associated disease

Screening for associated disease


Thyroid function testing
Anti-thyroid peroxidase testing
Blood glucose screen
Other autoimmune serologic tests based on physical exam findings
If long-standing, blood smear


Thyroid function testing
Anti-thyroid peroxidase testing
Blood glucose screen
Other autoimmune serologic tests based on physical exam findings
If long-standing, blood smear

Consider genetic testing


HLA-DQ2, HLA-DQ8

Consider genetic testing


HLA-DQ2, HLA-DQ8

Consider genetic testing

Consider genetic testing


HLA-DQ2, HLA-DQ8


HLA-DQ2, HLA-DQ8

DH, Dermatitis herpetiformis; DIF, direct immunofluorescence; eTG, epidermal transglutaminase; H&E, hematoxylin and eosin; HLA-DQ2, histocompatibility locus antigen haplotype DQ2; HLA-DQ8, histocompatibility locus antigen haplotype DQ8; Ig, immunoglobulin; tIG, tetanus immune globulin.

DH, Dermatitis herpetiformis; DIF, direct immunofluorescence; eTG, epidermal transglutaminase; H&E, hematoxylin and eosin; HLA-DQ2, histocompatibility locus antigen haplotype DQ2; HLA-DQ8, histocompatibility locus antigen haplotype DQ8; Ig, immunoglobulin; tIG, tetanus immune globulin.

DH, Dermatitis herpetiformis; DIF, direct immunofluorescence; eTG, epidermal transglutaminase; H&E, hematoxylin and eosin; HLA-DQ2, histocompatibility locus antigen haplotype DQ2; HLA-DQ8, histocompatibility locus antigen haplotype DQ8; Ig, immunoglobulin; tIG, tetanus immune globulin.

DH DIF eTG H&E HLA-DQ2 HLA-DQ8 Ig tIG