BackgroundBullous pemphigoid (BP) is an autoimmune blistering disease associated with autoantibodies against BP180 and/or BP230 antigens. The immunoassays available for serological diagnostics include indirect immunofluorescence (IIF) on monkey esophagus (ME), salt‐split skin (SSS), and enzyme‐linked immunosorbent assay (ELISA) for BP180‐NC16a and BP230. Only a few studies validated innovative BIOCHIP mosaic, but none compared agreement between BIOCHIP substrates with conventional methods separately.MethodsWe evaluated the agreement between BIOCHIP and conventional methods and assessed sensitivity and specificity in BP diagnosis. The study comprised 51 BP patients and 39 controls.ResultsAnalysis showed very good agreement between BIOCHIP‐SSS vs classic IIF‐SSS (0.933, P < 0.001) and for BIOCHIP‐BP180‐NC16a vs ELISA‐BP180‐NC16a (0.933, P < 0.001). A good strength of agreement between BIOCHIP‐ME vs classic IIF‐ME was observed (0.694, P < 0.001) similar to BIOCHIP‐BP230 vs ELISA‐BP230 (0.793, P < 0.001). BIOCHIP‐ME sensitivity was 51.0%, whereas IIF‐ME was 76.5%. Epidermal reaction on BIOCHIP‐SSS was found in 94.1% of BP patients and in all patients on IIF‐SSS (sensitivity 100%). BIOCHIP‐BP180‐NC16a sensitivity was lower than in ELISA‐BP180‐NC16a (76.5% vs 82.4%). BP230 sensitivity of both methods was similar (45.1% vs 43.1%). The specificity for all antigens was 100%.ConclusionBIOCHIP mosaic is a useful method presenting satisfactory agreement with conventional immunoassays.

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Pemphigoid nodularis is a rare form of pemphigoid that joins the clinical picture of prurigo nodularis and the immunological features of bullous pemphigoid, which is therapeutically challenging. Here, we analyze five female patients with a long-lasting course of nodular pemphigoid in terms of clinical and immunological characteristics and therapy. All the patients fulfilled clinical and immunological criteria of nodular pemphigoid. We applied numerous techniques allowing the proper diagnosis: direct and indirect immunofluorescence, salt split skin, ELISA, BIOCHIP, and fluorescence overlay antigen mapping using laser scanning confocal microscopy. Our study showed that 4 of 5 patients fulfilled the clinical and immunological criteria of nodular bullous pemphigoid. Two out of 4 patients presented exclusively nodular lesions; in the other two patients, blisters and erythematous lesions preceded prurigo-like lesions by a few years. The remaining patient had clinical and immunological criteria of nodular mucous membrane pemphigoid, presenting oral erosions, scarring conjunctivitis, and numerous disseminated nodules on the skin. All the patients were treated with multiple medicines; however, it was observed that the use of clobetasol propionate on the entire body plus antidepressants best controlled the disease. Pemphigoid nodularis mainly occurs in elderly women. In cases with coexisting psychological problems, antidepressants should be considered as an important complementary therapy to the basic one with clobetasol propionate.

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