To the Editor.—
Drs. Cohen and Frank accurately restate our position that the diagnostic criteria for dermatitis herpetiformis (DH) should be the same in children as in adults—clinical, histologic, and response to therapy. However, we did not state that the predominantly bullous, nonpruritic, sulfoneresistant disease in children should be diagnosed as bullous pemphigoid. That idea, proposed by Kim and Winkelmann,1 has not yet been validated histologically or by demonstration of the basement membrane antibodies characteristic of bullous pemphigoid.2We stressed the unique histology of DH in children and adults.3-5 None of the cases of bullous disease in children reputed to be DH, apparently including those of Drs. Cohen and Frank, have been shown to have that distinctive histology. Should a bullous disease in children, that does not resemble adult DH clinically or histologically, be designated DH solely because it responds to sulfone therapy? We think not. The
Ackerman AB, Tolman MM. DERMATITIS HERPETIFORMIS-Reply. Arch Dermatol. 1970;101(2):251. doi:10.1001/archderm.1970.04000020121022
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