Immunofluorescent localization of basement membrane in lesions of dermatitis herpetiformis

Dermatitis herpetiformis (DH) is a blistering disease with a characteristic histology that includes papillary edema, neutrophilic papillary microabscesses, and development of subepidermal blisters. In spite of this pathologic sequence occurring entirely beneath the basement membrane zone, prior studies have indicated that the basement membrane, as defined by period acid-Schiff (PAS) or silver stains, lies at the floor of fully formed blisters or is destroyed by the disease process. To more accurately assess its location in primary lesions of DH, the basement membrane was stained using immunofluorescent techniques. Lesional skin from 5 patients with DH was used as substrate for indirect immunofluorescence with sera from patients with bullous pemphigoid (BP) and fluoresceinated antihuman IgG. The BP-stained basement membrane was attached to the roofs of early blisters, where it would be expected from the pathologic sequence of blister formation. PAS stains of the same or serial sections show the basement membrane to be in the roof or at the floor of the blisters. PAS stains of sections from formalin-fixed lesional skin, on the other hand, show the basement membrane to routinely lie at the blister floor, when not destroyed. The BP-stained epidermal basement membrane has greater anatomic and functional significance than either the PAS-or silver-stained basement membrane for two reasons: (1) it corresponds to a specific morphologic structure, the lamina lucida, a part of the epidermis, and remains attached to the rest of the epidermis unless destroyed; and (2) it is antigenic, capable of binding with BP antibodies.