To the Editors.—
I would like to speculate on the pathologic condition of the patient described by Vincendeau et al in the June Archives (1980;116:681-682) as having a bullous dermatosis, without determining the "exact ultrastructural localization of blistering." At the right side of Fig 2 in their article, the bulla seems to form intradermally below a normal epidermis and a normal basement membrane zone. Since myeloma is often associated with amyloidosis, stains for amyloid might have shown that the bulla is formed by cleavage through fragile dermal amyloid deposits.1 The immunofluorescence microscopy findings would probably be unrelated to or secondary to bulla formation.
Bluhm JF. Bullous Dermatosis vs Amyloidosis. Arch Dermatol. 1981;117(5):252. doi:10.1001/archderm.1981.01650050006007