Bullous disease in systemic lupus erythematosus

We describe three women with systemic lupus erythematosus and vesiculobullous skin lesions. One patient had a generalized bullous dermatosis and circulating anti-basement membrane zone IgG autoantibodies. Two patients had vesiculobullous lesions limited to the face. All patients had subepidermal blisters and an infiltrate of neutrophils and linear IgG, IgM, IgA, and C3 deposits along the basement membrane zone. These deposits were located in the sublamina densa. Ultrastructural investigation revealed a dermatolytic bullous disease in the patient with the generalized bullous eruption and anti-basement membrane zone autoantibodies and junctional blistering in those patients who had localized blistering.