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Article
February 1988

Persistent Subepidermal Blistering in Split-Thickness Skin Graft SitesUltrastructural and Antigenic Features Simulating Dystrophic or Immunofluorescence-Negative Acquired Epidermolysis Bullosa

Author Affiliations

From the Departments of Dermatology (Drs Epstein, Hendrick, Sanchez, and Solomon) and Pathology (Drs Sanchez and Solomon), University of Texas Medical Branch, Galveston; the Department of Dermatology, University of Alabama at Birmingham (Dr Fine); and Birmingham (Ala) Veterans Administration Medical Center (Dr Fine).

Arch Dermatol. 1988;124(2):244-249. doi:10.1001/archderm.1988.01670020062019
Abstract

• We describe a child who began developing subepidermal blisters in the recipient sites of split-thickness skin grafts; this process has continued for almost a year and continues to spare nongrafted skin. Routine histologic and immunofluorescence mapping studies demonstrated this disorder to be a relatively noninflammatory one characterized by sub-lamina densa blister formation. Results of direct immunofluorescence were negative. By electron microscopy, anchoring fibrils were sparse in number and in some areas appeared malformed; otherwise, the basement membrane zone was morphologically unremarkable. Bullous pemphigoid antigen, laminin, type IV collagen, epidermolysis bullosa acquisita antigen, and LDA-1 were all normally expressed along the dermoepidermal junction. In contrast, KF-1 antigen was absent. These findings suggest a disease process confined to skin graft recipient sites with features identical to those previously described with recessive dystrophic or immunofluorescence-negative acquired epidermolysis bullosa.

(Arch Dermatol 1988;124:244-249)

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