Isolated Hand Involvement as the Presenting Sign of Dermatitis Herpetiformis

Dermatitis herpetiformis (DH) is an autoimmune blistering disease associated with celiac disease, classically presenting as intensely pruritic erythematous vesicles and papules on the elbows, knees, buttocks, and scalp. Involvement of the dorsal hands is extremely rare, complicating diagnosis. We report a unique case of DH confined solely to the dorsal hands in a 68-year-old woman with a five-year history of recurrent, pruritic vesicles initially misdiagnosed as hand eczema. Direct immunofluorescence confirmed the diagnosis of DH with granular immunoglobulin (Ig) A deposition along the dermo-epidermal junction, and serologic testing revealed elevated tissue transglutaminase IgA. This case highlights an uncommon presentation of DH and emphasizes the need to consider it in chronic, unexplained dorsal hand eruptions to prevent misdiagnosis and delayed treatment.