Bullous Diseases

Immunoelectron microscopy and immunofluorescence combined with the use of serum autoantibodies or prepared monoclonal antibodies have led to a better understanding of the structure and function of the basement membrane zone and of the location and nature of the antigens involved in bullous diseases. The immunofluorescent techniques have proved their worth for the diagnosis of bullous diseases, even if in some instances the clinician is left somewhat disconcerted when patients with an apparently specific clinical entity prove to have diverse immunological findings. Immunofluorescent methods have, in addition, thrown light on pathogenesis notably in pemphigus and pemphigoid where autoantibodies against epidermal components have a key role. As with other autoimmune diseases the initiating mechanism remains obscure. Equally obscure is the pathogenesis of dermatitis herpetiformis where the relationship to gluten enteropathy and the importance of IgA remain to be explained.