Localization of bullous pemphigoid antibody--an indirect immunofluorescence study of 228 cases using a split-skin technique.
We have re-examined the site of deposition of IgG anti-basement membrane zone antibodies in 228 sera from suspected cases of bullous pemphigoid (BP), using 1.0 M sodium chloride split-skin as substrate for indirect immunofluorescence. Nine sera (4%) produced fluorescence on the floor of the split suggesting sub-basal lamina antibody deposition compatible with a diagnosis of epidermolysis bullosa acquisita (EBA). This ultrastructural localization was confirmed in only three of these nine by immuno-electron microscopy. Clinical details were available on six of these nine cases, and none had clinical features suggesting EBA. We have found the split-skin immunofluorescence technique unhelpful in identifying 'missed' cases of EBA. The prevalence of EBA presenting as BP would appear to be very low indeed in the U.K.
Logan
R A
RA
United Medical Schools of Guy's Hospital, London, U.K.
Bhogal
B
B
Das
A K
AK
McKee
P M
PM
Black
M M
MM
D001485:Basement Membrane / Q000276:immunology; D004820:Epidermolysis Bullosa / Q000276:immunology; D005455:Fluorescent Antibody Technique; D006652:Histological Techniques; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis*; D010391:Pemphigoid, Bullous / Q000276:immunology*; D012867:Skin / Q000276:immunology*; D012872:Skin Diseases, Vesiculobullous / Q000276:immunology*
D007074:Immunoglobulin G