A Study of Fluorescence Pattern of Immune Deposits in Bullous Pemphigoid and Epidermolysis Bullosa Acquisita

Kim, Jin Bok; Lee, Chang Woo

Abstract

Backgraund : Most of the inflammatory bullous lesions in bullous pamphigoid(BP) and epidermolysis bullosa acquisite(EBA) demonstrate similar clinical and histological features. However, the specificities of the autoantibodiea reactive to the dermo-epidermal junction antigeins are different. In these two bullouk dermat loses, there are no remarkable differences in symptomaiology, there are no unique predilection sites for the lesions and they do not usually leave scars after nvolution. Considering these similarities, dermatologists could encounter some clinical confuiion in maling a provisional diagnosis.
OBJECTIVE
Authors examined three patients of BP with classic inflammatory bullous eruptions and threa patients of EBA with inflammatory bullous lesions to see if here were any differences in the morphology of the immuno-fluorescence(IF) pattern.
METHODS
For direct IF of vertical or semi-vertical sections, perilasional skin was obtained in each patient for indirect IF of horizontal or semi-horizonta1 sections, Ig(bound substrates were prepared from all these autoantibody-positive individuals. All specimens veri; observed at 200/400-magnification fields through an ordinary fluorescence microscopy.
RESULTS
Patterns of fluorescence observed by direct IF were characterized as thin-linear in BP and thick/coarse-linear in EBA along the basement membrane zone. On the horizontal section preparations in indirect IF, the patterns of fluorescence were clean-linear in E3P hnd more fluffy-linear in EBA at the dermoepidermal junction, These patterns could be recognized aim/larly in the fields of both 200 and 400-magnification, however each minor differences were not easy to distinguish each other.
CONCLUSION
The above findings of subtle differences in the pattern of IF may provide some suggestions to the examiners for the need of differential diagnosis in theae riseases.