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October 1990

Repeat Direct Immunofluorescence to Discriminate Pemphigoid From Epidermolysis Bullosa Acquisita

Author Affiliations

Department of Dermatology Oregon Health Sciences University 3181 SW Sam Jackson Park Rd Portland, OR 97201-3098

Arch Dermatol. 1990;126(10):1365. doi:10.1001/archderm.1990.01670340117021

To the Editor.—  A recent publication by Zhu and coworkers1 examined antibody-positive serum samples from 100 sequential patients on sodium chloride-split skin and by Western immunoblot to distinguish bullous pemphigoid from epidermolysis bullosa acquisita. Five percent of unselected patients were shown to have epidermolysis bullosa acquisita.An editorial in the same issue of the Archives2 brings the problem of such studies into focus. Less than 50% of patients with epidermolysis bullosa acquisita or bullous pemphigoid have free, circulating antibodies capable of reacting with normal salt-split skin. Thus, a determination by indirect immunofluorescence can only be ascertained in less than half of such individuals. The editorial cites an article by Gammon et al3 that showed direct immunofluorescence on perilesional skin incubated in 1 mol/L of sodium chloride induces a separation at the dermoepidermal junction through the lamina lucida. This allowed detection of complement or antibody to (1) epidermis alone

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