Anti-P 200 pemphigoid - The most common floor binding subepidermal autoimmune bullous disease in a tertiary care center in south India.

BACKGROUND: The pemphigoid group of diseases may present clinically and immunologically in a very similar fashion. Indirect immunofluorescence microscopy with readily available salt-split human skin in a BIOCHIP™ helps to classify these conditions as those with either with roof binding or floor binding of immunoreactants. Epidermolysis bullosa acquisita, anti-laminin 332 pemphigoid and anti-p200 pemphigoid show floor binding, while in the most frequent type of pemphigoid disease, bullous pemphigoid, epidermal side staining pattern is seen on salt-split skin Aims: The aim of the study was to detect the target antigens in sub-epidermal bullous diseases. METHODS: Forty patients with bullous pemphigoid diagnosed by lesional histopathology and direct immunofluorescence microscopy were re-evaluated by a BIOCHIP™ mosaic containing both tissue substrates and recombinant target antigens. Sera with floor pattern staining on salt-split skin were further evaluated by immunoblotting with dermal extract. RESULTS: Five patients with floor staining had anti-p200 pemphigoid. LIMITATIONS: We could not perform serration pattern analysis of direct immunofluorescence in our patients. CONCLUSION: Histopathology and direct immunofluorescence microscopy cannot differentiate between various entities of pemphigoid diseases. A multivariant approach using a BIOCHIP™ mosaic including salt-split skin followed by immunoblotting with dermal extract helps to identify the target antigen.

Allergic contact dermatitis to superglue.

Wigs are commonly used to cover baldness. A 28 year old male presented with itchy oozy eythematous lesions on the forehead where the wig was afixed to the scalp. Patch testing with indian standard seies and dental series revealed positivity to 2-hydroxy ethyl meta acrylate present in superglue. We report this case for its clinical rarity.

Blister fluid immunofluorescence in a case of pemphigus vulgaris.

Indirect immunofluorescence with serum is used in the diagnosis of pemphigus. We report a case in whom blister fluid was used as the specimen for indirect immunofluorecscence.

Herpes misdiagnosed as pyoderma gangrenosum.

Retroviral infection is known to cause varied manifestation of any disease. We report a 27-year-old female who presented with non-healing painful ulcer in the left hand of 6 months' duration. The patient was diagnosed as pyoderma gangrenosum and treated with immunosuppressant drugs. One month later, she developed perianal vesicles and Tzanck smear from the vesicles showed multinucleated giant cells. A workup for sexually transmitted disease revealed HIV 1 Elisa to be positive. Diagnosis of herpetic ulcer was made and treated with famciclovir and hand ulcer gradually healed in 25 days. We report this case to highlight the occurrence of herpetic ulcer in an unusual site in a HIV patient and may lead to misdiagnosis of pyoderma gangrenosum.