Circulating bullous pemphigoid autoantibodies in the setting of negative direct immunofluorescence findings for bullous pemphigoid: A single-center…

A new interesting article has been published in J Am Acad Dermatol. 2019 Aug;81(2):472-479. doi: 10.1016/j.jaad.2019.03.062. Epub 2019 Mar 28. and titled:

Circulating bullous pemphigoid autoantibodies in the setting of negative direct immunofluorescence findings for bullous pemphigoid: A single-center…

Authors of this article are:

Wang M, Lehman JS, Camilleri MJ, Drage LA, Wieland CN.

A summary of the article is shown below:

BACKGROUND: Bullous pemphigoid (BP) autoantibody levels are generally elevated in patients with BP but can be present nonspecifically in patients without BP.OBJECTIVE: To analyze the clinical findings of patients with elevated BP180 or BP230 autoantibody levels and negative direct immunofluorescence (DIF) study findings.METHODS: We retrospectively reviewed records of patients seen at our institution during January 1, 2005-December 31, 2015, who were positive for BP180 or BP230 autoantibodies and had a negative DIF study finding. These patients’ demographic characteristics and BP180 and BP230 levels were compared with those of a BP control group who were positive for BP180 or BP230 autoantibodies and had positive DIF study findings.RESULTS: We identified 208 patients with BP autoantibodies but without positive DIF study findings. These patients’ mean age and enzyme-linked immunosorbent assay values were significantly lower than those of the control group. Dermatitis was the most common final clinical diagnosis. Of the 208 patients, 41 (19.7%) had at least 2 years’ follow-up. Four patients had positive DIF results upon repeating the test and ultimately received pemphigoid diagnoses.LIMITATIONS: Retrospective design with limited follow-up.CONCLUSION: Patients might harbor serum BP autoantibodies in the context of a wide range of dermatoses. Low positive BP180 and BP230 autoantibody levels should not be overinterpreted as evidence for BP in the setting of a negative DIF.Copyright © 2019 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

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This article is a good source of information and a good way to become familiar with topics such as: autoantibody;basement membrane zone;bullous diseases;immunobullous;immunofluorescence;medical dermatology;pemphigoid.

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