The main sign that accompanies DH is the eruption of intensely pruritic papulovesical lesions that typically present bilaterally on the elbows, knees, buttocks, neck, and scalp (Criado et al., 2012). They may appear on the upper back, abdomen, groin, and face as well. The lesions are small blisters that resemble those that are caused by the herpes simplex virus. By the time a patient seeks evaluation by a care provider, the lesions have often been scratched so much as to cause erosions, excoriation, and or crusted papules (Junkins-Hopkins, 2010). The surrounding area may have erythema and or urticarial plaques. Patients may have areas of hyperpigmentation from previous outbreaks (Bonciani et al., 2012). The breakouts are of a chronic nature and will have periods of flare ups and remission. The periods of remission do not typically last long than several weeks (Criado et al., 2012). The hallmark symptom that patients with DH report is extremely intense itching. They may report experiencing the itching, a burning and or a stinging sensation up to 12 hours prior to eruptions on the skin
