Info

Nonscarring

Split in lamina lucida area

Abbreviation: DEJ, dermal-epidermal junction.

Abbreviation: DEJ, dermal-epidermal junction.

Classification Variants, Mutations, and Other:

■ Vancomycin the best-documented causative drug

■ Preceding infection and hematopoietic malignancy also associated with linear IgA bullous dermatosis

BULLOUS LUPUS ERYTHEMATOSUS Clinical:

Bullous lupus erythematosus is characterized by widespread or localized nonscarring vesiculobullous eruption on the upper trunk, face, scalp, and/or extremities (Fig. 8A). The blistering is usually self-limiting and typically occurs in a patient with a flare of known systemic lupus erythematosus.

Histology (Figs. 8B and D):

■ Linear neutrophilic interface dermatitis

■ Sometimes papillary microabscesses of neutrophils as in dermatitis herpetiformis

■ Neutrophilic dust and extension of infiltrates into papillary dermis (not seen in dermatitis herpetiformis or in linear IgA bullous disease)

Differential Diagnosis:

■ Dermatitis herpetiformis; linear IgA bullous disease

Immunofluorescence:

■ DIF: always IgG, usually IgA, and sometimes IgM and C along the basement membrane zone in granular (60%), linear (40%), and sometimes mixed patterns

■ IIF: circulating antibodies not usually seen when utilizing monkey esophagus epithelium

■ IIF-SSS: immunoreactants that bind to the dermal side of the split

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