Comment on “Dermatitis herpetiformis in an African woman”, the importance of direct immunofluorescence assay

Abstract

This a reply letter to Machona MS et al.'s work. Authors describe a case of dermatitis herpetiformis (DH) solved after a gluten-free diet, associated to dapsone treatment. According to guidelines, in patients with clinical and/or histopathological findings suggestive for DH, a direct immunofluorescence (DIF) assay on perilesional skin, together with anti-tissue transglutaminase antibody dosage, are mandatory for a correct diagnosis. DIF remains the gold standard for DH diagnosis. This examination was not performed by authors, as well as serological parameters. Since autoimmune blistering skin diseases comprise different entities, a correct diagnosis is needed for accurate treatment and follow-up. In our opinion, the diagnosis in this case could be consistent with linear IgA bullous dermatosis more than DH, and the clinical and histopathological examinations could not be considered criteria sufficient enough to establish a diagnosis of DH.