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Deposition of Granular IgA Relative to Clinical Lesions in Dermatitis Herpetiformis

Deposition of Granular IgA Relative to Clinical Lesions in Dermatitis Herpetiformis Abstract Objective: To compare the deposition of IgA and C3 in the skin of patients with active dermatitis herpetiformis relative to the sites of disease. Design: In the phase 1 study, skin biopsy specimens were obtained from erythematous perilesional skin, nonerythematous perilesional skin, and never-involved skin. In the phase 2 study, specimens from the nonerythematous perilesional and uninvolved skin from the same anatomic region were sampled. Setting: The Dermatology Clinic at the University of Utah Health Sciences Center, Salt Lake City. Patients: Patients with known dermatitis herpetiformis: 19 patients in the phase 1 study and 15 patients in the phase 2 study. Suppressive medications were stopped for 48 to 72 hours after biopsy specimens were obtained. All patients had active disease at the time that biopsy specimens were taken. Main Outcome Measure: The intensity of IgA and C3 immunofluorescent staining in 6 sections from each skin biopsy specimen was graded by using a semiquantitative scale (0 to 3+) in a blinded fashion by a single ob Results: Deposition of IgA was more intense in noninflamed perilesional skin in 11 of 19 patients compared with that in erythematous skin (P<.05). Erythematous skin was negative for IgA in 16% (3/19) of the specimens. Noninflamed perilesional skin showed more intense IgA deposition in 18 of 19 specimens compared with that in never-involved skin (P<.01); C3 was more intense in erythematous skin (P<.01). In the phase 2 study, skin from the same anatomic region revealed greater deposition of IgA near lesions in 12 of 15 patients (P<.001). Conclusions: In patients with dermatitis herpetiformis, IgA is not uniformly distributed throughout the skin, and IgA is present in greater amounts near active lesions. The preferred biopsy site for the diagnosis of dermatitis herpetiformis is normal-appearing skin that is adjacent to an active lesion.Arch Dermatol. 1996;132:912-918 References 1. Leonard J, Haffenden G, Tucker W, et al. Gluten challenge in dermatitis herpetiformis . N Engl J Med. 1983;308:816-819.Crossref 2. Zone JJ. Dermatitis herpetiformis . In: Weston WL, Mackie RM, Provost TT, eds. Current Problems in Dermatology . St Louis, Mo: Mosby—Year Book; 1991; 3:1-41. 3. Fry L, Haffenden G, Wojnarowska F, Thompson BR, Seah PP. IgA and C3 complement in the uninvolved skin in dermatitis herpetiformis after gluten withdrawal . Br J Dermatol. 1978;99:31-37.Crossref 4. Frodin T, Gotthard R, Hed J, Molin L, Norrby K, Walan A. Gluten-free diet for dermatitis herpetiformis: the long-term effect on cutaneous, immunological and jejunal manifestations . Acta Derm Venereol. 1981;61:405-411. 5. Egelrud T. Dermatitis herpetiformis: selective deposition of immunoglobulin A1 in granular deposits in clinically normal skin . Acta Derm Venereol. 1986; 66:11-15. 6. van der Meer JB. Granular deposits of immunoglobulins in the skin of patients with dermatitis herpetiformis: an immunofluorescent study . Br J Dermatol. 1969; 81:493-503.Crossref 7. Chorzelski TP, Beutner EH, Jablonska S, Blaszczyk M, Triftshauser C. Immunofluorescence studies in the diagnosis of dermatitis herpetiformis and its differentiation from bullous pemphigoid . J Invest Dermatol. 1971;56: 373-380.Crossref 8. Seah PP, Fry L, Stewart JS, Chapman BL, Hoffbrand AV, Holborow EJ. Immunoglobulins in the skin in dermatitis herpetiformis and coeliac disease . Lancet. 1972;1:611-614.Crossref 9. Haffenden G, Wojnarowska F, Fry L. Comparison of immunoglobulin and complement deposition in multiple biopsies from the uninvolved skin in dermatitis herpetiformis . Br J Dermatol. 1979;101:39-45.Crossref 10. Fleiss J. Statistical Methods for Rates and Proportions . New York, NY: John Wiley & Sons Inc; 1973:143-147. 11. Fry L, Leonard JN, Swain F, et al. Long term follow-up of dermatitis herpetiformis with and without dietary gluten withdrawal . Br J Dermatol. 1982;107: 631-640.Crossref 12. Fry L, McMinn RMH, Cowan JD, Hoffbrand AV. Effect of gluten-free diet on dermatological, intestinal, and haematological manifestations of dermatitis herpetiformis . Lancet. 1968;1:557-561.Crossref 13. Ljunghall K, Tjernlund U. Dermatitis herpetiformis: effect of gluten-restricted and gluten-free diet on dapsone requirement and on IgA and C3 deposits in uninvolved skin . Acta Derm Venereol Suppl Stockh. 1983;63:129-136. 14. Reunala T. Gluten-free diet in dermatitis herpetiformis, II: morphological and immunological findings in the skin and small intestine of 12 patients and matched controls . Br J Dermatol. 1978;98:69-78.Crossref 15. Seah PP, Mazaheri MR, Fry L. Complement in the skin of patients with dermatitis herpetiformis . Br J Dermatol. 1973;89( (suppl) ):12.Crossref 16. Gammon WR, Ruddy S, Sams MW, Carlo JR. Relationship of b1H globulin and cleavage fragments of the third component of complement in the skin of patients with bullous pemphigoid and dermatitis herpetiformis . Clin Immunol Immunopathol. 1981;20:21-30.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Deposition of Granular IgA Relative to Clinical Lesions in Dermatitis Herpetiformis

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Publisher
American Medical Association
Copyright
Copyright © 1996 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.1996.03890320060010
Publisher site
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Abstract

Abstract Objective: To compare the deposition of IgA and C3 in the skin of patients with active dermatitis herpetiformis relative to the sites of disease. Design: In the phase 1 study, skin biopsy specimens were obtained from erythematous perilesional skin, nonerythematous perilesional skin, and never-involved skin. In the phase 2 study, specimens from the nonerythematous perilesional and uninvolved skin from the same anatomic region were sampled. Setting: The Dermatology Clinic at the University of Utah Health Sciences Center, Salt Lake City. Patients: Patients with known dermatitis herpetiformis: 19 patients in the phase 1 study and 15 patients in the phase 2 study. Suppressive medications were stopped for 48 to 72 hours after biopsy specimens were obtained. All patients had active disease at the time that biopsy specimens were taken. Main Outcome Measure: The intensity of IgA and C3 immunofluorescent staining in 6 sections from each skin biopsy specimen was graded by using a semiquantitative scale (0 to 3+) in a blinded fashion by a single ob Results: Deposition of IgA was more intense in noninflamed perilesional skin in 11 of 19 patients compared with that in erythematous skin (P<.05). Erythematous skin was negative for IgA in 16% (3/19) of the specimens. Noninflamed perilesional skin showed more intense IgA deposition in 18 of 19 specimens compared with that in never-involved skin (P<.01); C3 was more intense in erythematous skin (P<.01). In the phase 2 study, skin from the same anatomic region revealed greater deposition of IgA near lesions in 12 of 15 patients (P<.001). Conclusions: In patients with dermatitis herpetiformis, IgA is not uniformly distributed throughout the skin, and IgA is present in greater amounts near active lesions. The preferred biopsy site for the diagnosis of dermatitis herpetiformis is normal-appearing skin that is adjacent to an active lesion.Arch Dermatol. 1996;132:912-918 References 1. Leonard J, Haffenden G, Tucker W, et al. Gluten challenge in dermatitis herpetiformis . N Engl J Med. 1983;308:816-819.Crossref 2. Zone JJ. Dermatitis herpetiformis . In: Weston WL, Mackie RM, Provost TT, eds. Current Problems in Dermatology . St Louis, Mo: Mosby—Year Book; 1991; 3:1-41. 3. Fry L, Haffenden G, Wojnarowska F, Thompson BR, Seah PP. IgA and C3 complement in the uninvolved skin in dermatitis herpetiformis after gluten withdrawal . Br J Dermatol. 1978;99:31-37.Crossref 4. Frodin T, Gotthard R, Hed J, Molin L, Norrby K, Walan A. Gluten-free diet for dermatitis herpetiformis: the long-term effect on cutaneous, immunological and jejunal manifestations . Acta Derm Venereol. 1981;61:405-411. 5. Egelrud T. Dermatitis herpetiformis: selective deposition of immunoglobulin A1 in granular deposits in clinically normal skin . Acta Derm Venereol. 1986; 66:11-15. 6. van der Meer JB. Granular deposits of immunoglobulins in the skin of patients with dermatitis herpetiformis: an immunofluorescent study . Br J Dermatol. 1969; 81:493-503.Crossref 7. Chorzelski TP, Beutner EH, Jablonska S, Blaszczyk M, Triftshauser C. Immunofluorescence studies in the diagnosis of dermatitis herpetiformis and its differentiation from bullous pemphigoid . J Invest Dermatol. 1971;56: 373-380.Crossref 8. Seah PP, Fry L, Stewart JS, Chapman BL, Hoffbrand AV, Holborow EJ. Immunoglobulins in the skin in dermatitis herpetiformis and coeliac disease . Lancet. 1972;1:611-614.Crossref 9. Haffenden G, Wojnarowska F, Fry L. Comparison of immunoglobulin and complement deposition in multiple biopsies from the uninvolved skin in dermatitis herpetiformis . Br J Dermatol. 1979;101:39-45.Crossref 10. Fleiss J. Statistical Methods for Rates and Proportions . New York, NY: John Wiley & Sons Inc; 1973:143-147. 11. Fry L, Leonard JN, Swain F, et al. Long term follow-up of dermatitis herpetiformis with and without dietary gluten withdrawal . Br J Dermatol. 1982;107: 631-640.Crossref 12. Fry L, McMinn RMH, Cowan JD, Hoffbrand AV. Effect of gluten-free diet on dermatological, intestinal, and haematological manifestations of dermatitis herpetiformis . Lancet. 1968;1:557-561.Crossref 13. Ljunghall K, Tjernlund U. Dermatitis herpetiformis: effect of gluten-restricted and gluten-free diet on dapsone requirement and on IgA and C3 deposits in uninvolved skin . Acta Derm Venereol Suppl Stockh. 1983;63:129-136. 14. Reunala T. Gluten-free diet in dermatitis herpetiformis, II: morphological and immunological findings in the skin and small intestine of 12 patients and matched controls . Br J Dermatol. 1978;98:69-78.Crossref 15. Seah PP, Mazaheri MR, Fry L. Complement in the skin of patients with dermatitis herpetiformis . Br J Dermatol. 1973;89( (suppl) ):12.Crossref 16. Gammon WR, Ruddy S, Sams MW, Carlo JR. Relationship of b1H globulin and cleavage fragments of the third component of complement in the skin of patients with bullous pemphigoid and dermatitis herpetiformis . Clin Immunol Immunopathol. 1981;20:21-30.Crossref

Journal

Archives of DermatologyAmerican Medical Association

Published: Aug 1, 1996

References