Bullous pemphigoid antigen concentration in normal human skin in relation to body area and age

Abstract

The amount of bullous pemphigoid antigen (BPA) in normal human skin on different areas of the body and in bodies of different ages was determined by making endpoint titer estimations using the indirect immunofluorescence technique. Two sera with bullous pemphigoid antibodies were tested with 36 specimens of normal human skin from six cadavers. The greatest expression of BPA was found in plantar sites, whereas the lowest endpoint titers were seen in flexural arm biopsy specimens. Age-dependent differences in BPA expression were detected as well. The oldest individuals tested produced the highest endpoint titers in contrast to the lowest endpoint titers in the youngest. This study suggests that the amount of BPA depends not only on the body region where the biopsy specimen is taken but also on the age of the donor. This is important to know in connection with indirect immunofluorescence assays for BP antibodies on human skin.

Re‐evaluation of the natural course of bullous pemphigoid. A prospective study

“…This sequence of probability and extent/severity of involvement is not a random event, but seems to correspond with the body site quantitative BP antigen distribution as previously shown by experimental data. 17 − 19 The increased antigen concentration in conjunction with body fluid mechanics might explain the observed predilection of localized pemphigoid in the lower limbs either as a first expression or as a forme fruste in a disease exacerbation, but also may explain the increased relative frequency and extent/severity of involvement registered in the generalized forms 17 − 19,23 . The observed prevalence of the localized variety (13.5%) is in accordance with literature data when taking into account the respective 95% confidence limits 1,24 .…”

Localized pemphigoid on the soles of both feet

“…In a study on the distribution of the BP antigen in normal human skin, the greatest expression was found at plantar sites 22 . This might explain the plantar limitation in our patient.…”

Localized flexural bullous pemphigoid

“…LBP has been documented following radiotherapy,4 PUVA therapy, trauma,5 sunexposure,6 split skin grafting for burns,7 around peristomal lesions8 and several authors have thus postulated that these local factors might play a role in the induction of lesions in immunologically susceptible individuals. In a study on the distribution of bullous pemphigoid antigens in normal human skin the greatest expression was seen in the skin obtained from the flexor aspect of arms, legs and thighs9 which probably explains the predominant flexural localization of lesions in our case. Whether the ACE inhibitors contributed in triggering the bullous eruption here is not clear as the patient had been taking the above medications for almost a year.…”