Dermatitis herpetiformis and rheumatoid arthritis.

I have read with interest the case report entitled “Dermatitis herpetiformis and rheumatoid arthritis” by Aydog and colleagues,1 and I would like to add some comments to this interesting case. Actually, it is basic knowledge that direct immunofluorescence should always be positive in dermatitis herpetiformis (DH) and if there is a high degree of clinical suspicion, serial sections and multiple biopsies are necessary to confirm the diagnosis.2,3 Therefore, immunofluorescence is mandatory to diagnose DH and clinical findings or treatment response is only of less importance. Another important point, the biopsy should be taken from clinically normal skin. In the article, the author did not specify the site of the biopsy. Lastly, any inflammation involving neutrophils should respond to dapsone so improvement was expected even if the case was not DH. I think these are valuable comments for the authors to reconsider in the diagnosis of this condition, and I look forward to their response .