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March 1991

Acquired Epidermolysis Bullosa With the Clinical Feature of Brunsting-Perry Cicatricial Bullous Pemphigoid

Author Affiliations

From the Departments of Dermatology, Ludwig-Maximilians, University of Munich (Federal Republic of Germany) (Drs Kurzhals, Stolz, Meurer, Braun-Falco, and Krieg) and St Barbara-Hospital Duisburg (Federal Republic of Germany) (Dr Kunze). Dr Kurzhals is now with the Department of Dermatology, Städtisches Krankenhaus München-Schwabing.

Arch Dermatol. 1991;127(3):391-395. doi:10.1001/archderm.1991.01680030111016

• A 56-year-old woman with the typical clinical feature of cicatricial bullous pemphigoid of the Brunsting-Perry type was studied. Histologic examination of a lesional skin biopsy specimen demonstrated a subepidermal blister. Direct immunofluorescence microscopy revealed linear deposits of IgG, IgM, and C3 located on both the roof and the floor of the blister. Immunofluorescence antigen mapping using cryostat sections of a spontaneous blister and antisera against defined basement membrane components localized the bullous pemphigoid antigen and type IV collagen in the roof of the blister. This dermal type of blister formation was confirmed by electron microscopy, which showed the cleavage level below the lamina densa. In direct immunoelectron microscopy, granular deposits of C3 and IgG were found attached to and just beneath the lamina densa in a pattern identical to the distribution of anchoring fibrils. These findings are diagnostic of acquired epidermolysis bullosa, a blistering disease that has much more clinical heterogeneity than previously suggested.

(Arch Dermatol. 1991;127:391-395)