Vesicle-like dermatitis may be an autoimmune disease caused by gluten sensitization on the basis of genetic constitution, leading to damage to the skin and small intestinal mucosa. The skin is characterized by polymorphic lesions such as erythema, papules, wheals, and chickenpox-like eruptions. It predominantly affects middle-aged males, with most patients exhibiting allergies to iodine, gluten, and dairy products.

This condition is rare, has a prolonged course, and alternates between exacerbations and remissions. However, the prognosis is favorable, with few fatalities. In children, the disease may resolve spontaneously after puberty.

bubble_chart Clinical Manifestations

1. Damage to diversity, presenting with erythema, papules, wheals, and chickenpox of varying sizes. Chickenpox lesions often cluster densely, with clear blister fluid, thick blister walls, and a negative Nikolsky sign. After chickenpox resolves, significant pigmentation remains. The course is chronic, characterized by recurrent episodes and remissions, resembling a sexually transmitted disease;
2. Skin lesions are mainly distributed on the scapulae, buttocks, arms, thighs, and extensor surfaces of the elbows and knees, with little to no oral mucosal involvement;
3. Cutaneous pruritus is severe, but systemic symptoms are rare;
4. Some patients may develop malabsorption syndrome and steatorrhea.

bubble_chart Diagnosis

1. The skin lesions are polymorphic, characterized by clustered or annular arrangement of serous vesicles;
2. the lesions are mainly symmetrically distributed on the shoulders, scapulae, buttocks, arms, sacrum, and extensor surfaces of the elbows and knees;
3. cutaneous pruritus is severe, but systemic symptoms are rare;
4. it may be accompanied by manifestations of malabsorption syndrome;
5. histopathology shows subepidermal chickenpox, without acantholysis, and abscesses dominated by neutrophils at the papillary tips;
6. direct immunofluorescence (DIF) examination of the perilesional and normal skin reveals granular IgA deposits at the papillary tips;
7. some cases show allergic reactions to iodine preparations;
8. small intestine biopsy shows focal villous atrophy and chronic inflammatory cell infiltration of the lamina propria.

bubble_chart Treatment Measures

1. Avoid foods containing gluten such as wheat-based foods, and avoid iodine-rich foods like kelp and seaweed;
2. Avoid iodine-containing medications;
3. Systemic drug therapy;
4. Local symptomatic treatment.

bubble_chart Cure Criteria

1. Cured: Rash subsided, symptoms disappeared, no new lesions;
2. Improved: Partial resolution of rash, symptoms alleviated, occasional new lesions;
3. No improvement: Continued appearance of new lesions, symptoms unchanged.