Childhood bullous pemphigoid: clinical and immunological findings in a series of 4 cases.
BACKGROUND
Bullous pemphigoid (BP) is an autoimmune blistering disease that is rare in childhood. As in adult BP, antibodies against the 180-kDa antigen (BP180) seem to be involved in the pathogenesis of the disease, but, to date, only a small number of children with the disease have been examined immunologically.


METHODS
We report the cases of 4 infants with BP aged 5 to 12 months. All of them had involvement of the hands and feet, and they all achieved a complete remission in less than 6 months when treated with oral prednisolone stearoyl glycolate. Three patients could be examined using antigen characterization techniques. Autoantibodies against the NC16A domain of BP180 were found by immunoblot assay in all 3 and by enzyme-linked immunosorbent assay in 2 of them. Interestingly, although IgA autoantibodies were detected in only 1 of them by indirect immunofluorescence, all of them had IgA autoantibodies, and 2 of the 3 had IgG autoantibodies against NC16A as detected by immunoblot assay. One patient also had IgG autoantibodies against the carboxyterminal domain of BP180.


CONCLUSIONS
IgA-specific antibodies against BP180 were detected in all our patients. These findings further raise the question about the relationship between BP and linear IgA bullous dermatosis, the most common autoimmune blistering disorder in children.
Martinez-De Pablo
Maria Isabel
MI
Department of Dermatology, Hospital Clinic, Barcelona, Spain. 34199mmd@comb.es
González-Enseñat
Maria Antonia
MA
Vicente
Asunción
A
Gilaberte
Montserrat
M
Mascaró
José Manuel
JM
D001323:Autoantibodies / Q000097:blood*; D003176:Complement C3 / Q000378:metabolism*; D006801:Humans; D007223:Infant; D008297:Male; D010391:Pemphigoid, Bullous / Q000097:blood* / Q000473:pathology* / Q000628:therapy
D001323:Autoantibodies; D003176:Complement C3