Persistent subepidermal blistering in split-thickness skin graft sites. Ultrastructural and antigenic features simulating dystrophic or immunofluorescence-negative acquired epidermolysis bullosa

Epstein, A.

doi:10.1001/archderm.124.2.244

Cited by 9 publications

(6 citation statements)

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“…An anchoring fibril defect has been proposed as the underlying cause of delayed postburn blisters (1,4). The staining for collagen VII in our study showed a discontinuous pattern in the blister roof, but this pattern was seen with the stains for the other basement membrane components as well and was consistent with the discontinuous structure of the basement membrane as observed by electron microscopy.…”

Section: Discussionsupporting

confidence: 86%

“…. , was performed, the blisters have been found to be subepidermal (2)(3)(4). Therefore, it has been assumed that the problem lies in the basement membrane zone and/or the superficial subepidermal connective tissue (1).…”

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confidence: 99%

“…Therefore, it has been assumed that the problem lies in the basement membrane zone and/or the superficial subepidermal connective tissue (1). Immunohistochemical mapping of the basement membrane and ultrastructural analysis, in a case with persistent subepidermal blistering in split-thickness skin graft site, suggested that the pathogenesis might be related to an anchoring fibril defect (4). In a more recent investigation, Chetty et al (2), who studied 13 cases with blisters at the donor, grafted, and spontaneously healed sites, observed by immunolocalization a highly variable distribution of basement zone components in the blisters, and by electron microscopy progressive loss of basal lami- na continuity from blister periphery to center.…”

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confidence: 99%

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Delayed postburn blisters: an immunohistochemical and ultrastructural study

Bergman¹,

David²,

Ramon³

et al. 1997

J Cutan Pathol

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This study was performed in an attempt to further elucidate the pathogenesis of delayed postburn blistering. Two cases were studied ultrastructurally and immunohistochemically, 1 with blisters on the recipient site of autologous split-thickness skin grafts and the other on the donor site. Ultrastructurally, the basement membrane was on the roof of the blisters in both cases, except for a single small blister in the first case where it was on the dermal floor. In the blister roofs, the basement membrane showed small or marked segments of discontinuity. In the adjacent non-blistered healed skin, the basement membrane was usually continuous, and anchoring fibrils were present. Immunoperoxidase staining on frozen sections, using antibodies to laminin, laminin 5, collagen IV, and collagen VII, showed a mostly continuous linear pattern in the adjacent non-blistered skin, which often became discontinuous near the blisters and markedly discontinuous in the blister roofs. In the blister floors, weakly stained linear or granular deposits of some of these components were sometimes also present. The results of this study support discontinuity of the basement membrane as the main anomaly in delayed postburn blistering. Disturbance in the reassembly or local breakdown of the basement membrane components might be the underlying defect.

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Section: Discussionsupporting

confidence: 86%

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confidence: 99%

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confidence: 99%

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Delayed postburn blisters: an immunohistochemical and ultrastructural study

Bergman¹,

David²,

Ramon³

et al. 1997

J Cutan Pathol

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“…Its pathogenic process is similar to that of human epidermolysis bullosa [17,19,31]. In the case of grafted human skin, further more, insufficient formation of BMZ proteins including type IV collagen, type VII collagen and laminin 5 cause detachment of the epidermis from the dermis [7,10]. Though such deterioration can be observed within the dermo-epidermal junction in early phase of acute laminitis, dissection of the chronically affected hoof shows existence of the hypertrophic LE between the ectopic white line tissue (lamellar wedge) and the distal phalanx [16,18,29].…”

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confidence: 97%

Unilateral Basement Membrane Zone Alteration of the Regenerated Laminar Region in Equine Chronic Laminitis

Kuwano

Ueno

Katayama

et al. 2005

The Journal of Veterinary Medical Science

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ABSTRACT. Between the laminar epidermis and the laminar dermis of laminar region (LR) in equine foot, it can be observed the basement membrane zone (BMZ), which is composed of a basement membrane and its accompaniments like the hemidesmosome and anchoring fibril. Alteration in the BMZ in equine laminitis is possibly related with not only development but also recovery outcome and recurrence of this disease. However, there is little known about the structure of the BMZ during the recovery phase of this disease. To assess the condition of the BMZ of LR affected by chronic laminitis, the tissue was examined in three cases at two weeks, four weeks and three months after the onset of laminitis, using pathological, immunohistochemical and electron microscopic techniques. Histologically in all laminitis cases, there was a regenerated laminar epidermis with proliferating keratinocytes between the Stratum medium and the dermis, but it included the undeveloped secondary epidermal laminae (ud-SELs) structure in one side of the primary epidermal laminae, especially in the part of the deep area of LR. Immunohistochemical results were positive for the anti-type IV collagen, anti-type VII collagen and anti-laminin 5 antibodies in the most BMZs. However, partial BMZs adjacent to the ud-SELs were negative for the anti-type VII collagen and anti-laminin 5 antibodies. Ultrastructurally, in the BMZ of the ud-SEL, the lamina densa and the lamina lucida were present. In contrast, the anchoring fibrils and the hemidesmosomes were either absent, or present at lower than normal levels. In conclusion, the present study indicated that the part of regenerated LR in chronic laminitis was not able to fully restore to construct the BMZ for a long time, especially in the unilateral side of laminar epidermis. It might be related with recurrence of this disease. KEY WORDS: basement membrane zone, chronic laminitis, collagen, equine, laminin 5.J. Vet. Med. Sci. 67 (7): [685][686][687][688][689][690][691] 2005 The integumental tissues of the foot are important in supporting the horse's entire body weight during static and dynamic loading conditions. If severe intractable hoof disease occurs, the horse may lose not only the ability to run, but also to stand. Laminitis is one such intractable hoof condition and has a recurrent nature. Many horses have suffered from this disease over extended periods, resulting in significant treatment costs, and therefore the equine industry has a great deal of interest in clarifying the pathogenesis and developing treatment methods [5,9,12].Anatomically, the laminar region in foot displays a complex 3-dimensional structure consisting of the primary epidermal lamina (PEL) and the secondary epidermal lamina (SEL) which interdigitate with their dermal counterparts [24]. These dermal and epidermal components are separated by the basement membrane zone (BMZ), which is composed of a basement membrane and its accompaniments like the hemidesmosome and anchoring fibril [23]. The hemidesmosome, anchoring fibril and other c...

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“…23 BSSs are commercially available, are easy to apply, and eliminate the need for donor-site harvesting. Although skin substitutes have been used to facilitate healing of chronic wounds in EB patients, 5,7,[24][25][26] their role in postsurgical defects in this population needs to be further investigated.…”

Section: Closure Optionsmentioning

confidence: 99%