A 26-year-old female presents with a rash on the back, elbows, buttocks and knees. The rash began acutely, associated with severe pruritis and burning sensation. Biopsy was done that shows immunofluorescence granular deposition of IgA in the papillary dermis, along the epidermal basement membrane zone and neutrophilic dermatitis within dermal papillae. So, what will be the course of management?

**Core Concept**
The clinical presentation and biopsy findings suggest a diagnosis of **Dermatitis Herpetiformis (DH)**, a chronic blistering skin condition characterized by **autoimmune** deposits of **IgA** in the skin. This condition is closely associated with **Celiac Disease**.

**Why the Correct Answer is Right**
The presence of **granular deposition of IgA** in the papillary dermis and along the epidermal basement membrane zone, along with **neutrophilic dermatitis**, is diagnostic of DH. The management of DH typically involves a strict **gluten-free diet** and may include the use of **dapsone** for symptomatic relief.

**Why Each Wrong Option is Incorrect**
**Option A:** Incorrect because it is not specified, but typically, treatments not targeting the autoimmune or gluten aspects of DH would be incorrect.
**Option B:** Incorrect for similar reasons as Option A, lacking specificity to DH management.
**Option D:** Incorrect as it does not address the autoimmune nature or the dietary management of DH.

**Clinical Pearl / High-Yield Fact**
A key point to remember is that DH is strongly associated with **Celiac Disease**, and management should include a **gluten-free diet** to control symptoms and prevent complications.

**Correct Answer:** D. Dapsone and gluten-free diet.

✓ Correct Answer: D. 2 and 3