Itchy rash with grouped vesicles

A 45-year-old man gave a five-year history of an extremely pruritic rash which was generalised and associated with itchy, grouped vesicles and papules that were excoriated. The rash was particularly prominent over the extensor surfaces of the limbs, but it was also present on the trunk (Figure 1) and face. A skin biopsy showed a subepidermal blister with intense neutrophilia at its base forming small subepidermal microabscesses (Figure 2). Direct immunofluorescence of some perilesional skin revealed granular deposits of IgA in the subepidermal zone (Figure 3).