Additional diagnostic tests often included in a celiac panel include antiendomysial antibodies and antigliadin antibodies Patients with DH should undergo endoscopy to assess for clinical evidence of gluten-sensitive enteropathy Treatment includes dapsone, which leads to spontaneous remission of DH in 24 to 48 hours Strict adherence to a gluten-free diet is recommended and may obviate the need for dapsone For comparison of the above autoimmune bullous diseases, see Table 67.3 Systemic Lupus Erythematosus Although not characteristic, widespread tense, bullous lesions can occur in systemic lupus erythematosus (SLE), usually in sun-exposed areas Multisystem involvement suggests the diagnosis Laboratory confirmation, which may include a skin biopsy and lupus band test, in conjunction with the complete clinical picture, is necessary for diagnosis OTHER BULLOUS ERUPTIONS THAT MAY BE CONFUSED WITH AUTOIMMUNE BLISTERING DISEASES Many times, the appearance of a rash is so characteristic that a diagnosis becomes obvious Such is the case with the conditions listed below, which are discussed in more detail in their respective chapters but are mentioned here for completeness when considering a vesiculobullous eruption Linear or geometric areas of vesiculation are the best clues to the presence of allergic contact dermatitis (see Chapter 65 Rash: Atopic/Contact Dermatitis and Photosensitivity ) The shape of the dermatitis provides the information that helps identify the offending agent A history of playing in a shrubbed area, camping, hiking, or being near burning leaves is helpful Because children brush against poison ivy leaves, vesicles often are in a line and on exposed surfaces (e.g., the face, extremities) A round group of vesicles on the back of the wrist would point to contact sensitivity to nickel contained in the metal case of a wristwatch Dermatomal distribution of vesicles or bullae usually indicates the presence of herpes zoster On rare occasions, in infants, the same dermatomal appearance may represent zosteriform herpes simplex infections Viral cultures, rapid slide tests using monoclonal antibodies, or more recently, polymerase chain reaction tests are utilized to differentiate herpes simplex from herpes zoster Target or iris lesions are pathognomonic of erythema multiforme The lesion has a dusky center that may blister and has successive bright red bordering rings At times, a doughnut-shaped blister occurs ( Fig 67.7 ) This contrasts with annular urticaria, in which incompletely round (arcuate or polycyclic) wheals are observed and individual lesions typically resolve within less than 24 hours (see