Epidermolysis Bullosa Acquisita With Negative Direct Immunofluorescence

To the Editor.—  In the September 1985 issue of the Archives, a 58-year-old man suffering from epidermolysis bullosa acquisita (EBA) with negative direct immunofluorescence (IF) findings was reported by Lacour et al.¹ The diagnosis of EBA was well established clinically and by electron microscopic investigations. Direct IF studies performed on six biopsy specimens over a period of two years revealed negative results; hence, the authors suggested the existence of a distinct subgroup of patients with EBA with no immunoglobulin deposits in the skin. Unfortunately, exact information concerning the skin sites from which the biopsy specimens were taken for IF investigations was not provided.Recently, Weigand² analyzed 41 cases of histologically confirmed bullous pemphigoid and demonstrated that in lesions originating in the lower extremities a third of direct IF tests turned out negative, whereas biopsy specimens tested from all other anatomic regions were found to have negative results in