Chapter 18 The skin/Fig 18.21.jpg

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Pemphigus vulgaris. (A) Direct immunofluorescence demonstrates a ‘chickenwire’ pattern of IgG deposition within the epidermis. The line drawing emphasizes the suprabasal site of bulla formation with preservation of the basal layer. (B) Bullous pemphigoid. Direct immunofluorescence demonstrates a linear band of IgG deposition along the basement membrane zone. The line drawing illustrates that the bulla is subepidermal; however, the basement membrane does remain attached to the dermis and forms the floor of the blister – this is not obvious on routine histology. Eosinophils are often the predominant cell type in the inflammatory infiltrate. (C) Dermatitis herpetiformis. Direct immunofluorescence shows coarse granules of IgA deposited in the papillary dermis. The line drawing shows a discrete focus of subepidermal blistering associated with an infiltrate of neutrophil polymorphs.