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12421 Pathology

A 35-year-old man has had an outbreak of pruritic lesions over the extensor surfaces of the elbows and knees during the past month. He has a history of malabsorption that requires him to eat a special diet, but he has had no previous skin problems. On physical examination, the lesions are 0.4- to 0.7-cm vesicles. A 3-mm punch biopsy of one of the lesions over the elbow is performed and on microscopic examination shows the accumulation of neutrophils at the tips of dermal papillae and the formation of small blisters caused by separation at the dermo-epidermal junction. Immunofluorescence studies show granular deposits of IgA localized to tips of dermal papillae. Laboratory studies show serum antigliadin antibodies. What is the most likely diagnosis?

ABullous pemphigoid
BContact dermatitis
CDermatitis herpetiformis
DDiscoid lupus erythematosus
Pathology
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