To the Editor.—
Direct and indirect immunofluorescence staining permitted an early diagnosis in a case of bullous pemphigoid that was preceded several months earlier by papular lesions.
Report of a Case.—
An 85-year-old woman was hospitalized for the first time in September 1979, for persistent pruritus of several months' duration. Physical examination disclosed excoriated papules distributed on the entire body, with the exception of the face, breasts, and abdomen. No cutaneous blisters or mucosal lesions were found. The clinical diagnosis was prurigo.Histologic examination of a papule disclosed a miniscule dermal-epidermal cleavage. The dermis contained a lymphohistiocytic infiltrate around the blood vessels. Direct immunofluorescence staining demonstrated a pseudolinear accumulation of IgG and C3 along the basement membrane zone. By indirect immunofluorescence staining, the serum titer of basement membrane zone antibodies was 1:1,000.A therapeutic regimen of 200 mg/day of sulfones (dapsone) produced some improvement in the pruritus and the papular
Lorette G, Fetissoff F. Papules With Basement Membrane Zone Antibodies Preceding Bullous Pemphigoid. Arch Dermatol. 1982;118(11):878-879. doi:10.1001/archderm.1982.01650230006010