Dermoscopy examination of petechial lesions in a patient with Dermatitis Herpetiformis

Abstract

An uncommon skin manifestation of Dermatitis Herpetiformis is palmar and plantar purpura. Dermoscopic examination is useful for any skin condition since it allows recognition of structures that are not discernible to the naked eye. A 22 year-old Caucasian man was admitted with excoriated lesions and pruritus. Petechial lesions could be seen on volar aspect of the digits on the hands and feet. Dermoscopy examination revealed erythematous and violaceous dots and erythematous and brown dots.

S2k guidelines (consensus statement) for diagnosis and therapy of dermatitis herpetiformis initiated by the European Academy of Dermatology and Venereology (EADV)

“…Acral purpurae and petechiae are a common cutaneous finding among DH patients and may even represent the initial manifestation of the disease 27,34–38 . Haemorrhagic skin lesions affect mostly the fingers and the toes (digital purpura).…”

Dermatite Herpetiforme Em Idade Pediátrica – Um Diagnóstico a Ter Em Conta

“…Clinicamente, a DH caracteriza-se por lesões vesico--bolhosas com fácil rutura e escoriação, lesões papulo--crostosas ou urticariformes, intensamente pruriginosas, por vezes agrupadas, dispostas sobretudo a nível das superfícies extensoras dos membros, região dorsal, cervical, glútea e peri-bucal. Ocasionalmente, sobretudo na criança, podem coexistir lesões petequiais ou purpúricas acrais 8 .…”

Acral Purpura in Dermatitis Herpetiformis

“…Dermatitis herpetiformis is an autoimmune skin disease associated with gluten sensitivity, typically producing highly pruritic papules and vesicles symmetrically distributed on the extensor surface of the elbows, knees, scalp, buttocks, back, and neck. [1][2][3][4] Palmar and plantar purpura have been described as a rare manifestation in this disease, most frequently present in children. 1,2 In most cases, the petechial or purpuric lesions appear in combination with other typical features, but sometimes they can be the first sign or even the only one.…”

“…2 The exact pathophysiologic mechanism is unknown, although minor traumas seem to play a role, since these lesions appear more often on the dominant hand. 1,3 Dermoscopy may be helpful in showing the hemorrhagic nature of acral lesions. 3 A skin biopsy with direct immunofluorescence is essential for diagnosis.…”

“…1,3 Dermoscopy may be helpful in showing the hemorrhagic nature of acral lesions. 3 A skin biopsy with direct immunofluorescence is essential for diagnosis. The histologic findings of petechial lesions are similar to those of vesicles in classic skin locations: an inflammatory infiltrate with neutrophils, edema, and subepidermal vesicles, with a dermal granular IgA deposition seen on the direct immunofluorescence study.…”