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February 1996

Advances in the Diagnosis of Subepidermal Bullous Diseases

Author Affiliations

Dermatology Branch, NCI Bldg 10 Room 12N238 National Institutes of Health 10 Center Dr MSC 1908 Bethesda, MD 20892; Salzburg, Austria

Arch Dermatol. 1996;132(2):220-222. doi:10.1001/archderm.1996.03890260122018

In THIS issue of the Archives, two articles1,2 appear that further our understanding of several acquired and inherited subepidermal bullous diseases. Both investigations are based on the application of immunofluorescence (IF) microscopy and the utilization of techniques and reagents that are the outgrowths of basic research in several fields. The fluorescence overlay antigen-mapping (FOAM) technique used by De Jong et al1 represents a technical advance that increases the sensitivity and resolution capability of conventional IF microscopy. These investigators have applied this technique to distinguish patients with bullous pemphigoid (BP) from those with epidermolysis bullosa acquisita (EBA). While routine direct IF microscopy has been used to facilitate the diagnosis of sub-epidermal bullous diseases for many years, limitations in their differentiation are commonly encountered. This occurs because findings in the skin of patients with BP, EBA, cicatricial pemphigoid, and rare cases of systemic lupus erythematosus are sometimes identical— specifically, linear

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