The disease always progresses by flare-ups with severe itching. Vesicles dry out, taking on a yellowish hue, and then shed in fine flakes. Old vesicles may be present alongside new ones. In bullous forms, the large blisters burst and there is weeping followed by formation of crusts. In the most severe forms, itching is so severe that it leads to incessant scratching, and the resulting pain is a considerable inconvenience for the patient in their daily life and work.