Vesicular pemphigoid vs dermatitis herpetiformis.

We describe a patient with clinical features of dermatitis herpetiformis (DH) and histopathologic features suggestive of both DH and bullous pemphigoid (BP). Immunofluorescent (IF) studies of skin biopsy revealed IgG and C3 deposits along the basement membrane zone (BMZ) in a linear pattern and circulating BMZ antibodies in the serum consistent with BP. The patient's condition evolved over 5 years into a typical case of DH characterized by histologic findings of papillary edema and neutrophilic infiltrates and evidence by IF findings of granular IgA deposits in the dermal papillae and the presence of antigliadin antibodies in the serum.