Snapshot A 33-year-old man has a 2 year history of recurrent blistering, and itchy eruptions, especially on his forearms. There are no exacerbating factors. He reports no gastrointestinal symptoms. He has a past medical history of hypothyroidism. Introduction Chronic autoimmune skin disease IgA anti-transglutaminase immune complex considered cutaneous manifestation of celiac disease Epidemiology males affected more than females (2:1) onset in adulthood Associated conditions other autoimmune conditions such as thyroid disease Presentation Skin findings severely itchy and burning blistering eruption clustered papules, vesicles, or excoriations symmetric distribution, especially on elbows and knees oral lesions uncommon Other findings typically no gastrointestinal symptoms Evaluation Skin biopsy gold standard direct immunofluorescence showing deposits of IgA at tips of dermal papillae subepidermal vesicles with neutrophilic infiltrate Small bowel biopsy villous atrophy Serologic testing endomysial antibodies tissue transglutaminase antibodies epidermal transglutaminase antibodies Differential Diagnosis Scabies (intense unremitting itching) Atopic dermatitis Treatment Lifestyle modifications gluten-free diet Pharmacological dapsone Prognosis, Prevention, and Complications Prognosis chronic disease spontaneous remission in 1/3 of cases Prevention can be well-controlled with dapsone or gluten-free diet Complications typically none