To the Editor.—
A case of epidermolysis bullosa acquisita (EBA) without immunoreactants similar to ours has been recently reported.1 The authors also did not specify the sites from which their two biopsy specimens were taken.We agree with Dusdet et al2 that it would be of interest to undertake a study on regional variation of the expression of EBA antigen. This is an absolute prerequisite before isolating a distinct subgroup of EBA without immunoglobulin deposits in the skin. There is an apparent correlation between the expression of bullous pemphigoid antigen and the location of clinical lesions.3 It is not yet established if this statement applies to EBA. However, this would suggest that skin lesions in this disorder are localized at sites of maximal concentrations of EBA antigen. This was obviously not the case in our patient as most biopsy specimens were taken from involved skin on the legs. In addition, suction blisters were raised on the abdomen of our patient, and a biopsy of these blisters was performed. Direct immunofluorescence on blisters and peribullous skin was negative. The possibility that IgG deposits were
Lacour JP, Ortonne JP. Epidermolysis Bullosa Acquisita With Negative Direct Immunofluorescence. Arch Dermatol. 1986;122(9):972. doi:10.1001/archderm.1986.01660210020004
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