Study On The Deposition Of Pemphigoid Antibodies IgG In The Follicles Of Plucked Hair From Patients With Bullous Pemphigoid

ObjectivesBullous pemphigoid is clinically characterized by vesicles or bullas that are not easy to break, from which the elder are more often suffering. Subepidermal vesicles formation, eosinophiles infiltrating and linear deposits of IgG and C3 in the dermal - subepidermal junction are the main pathological changes in BP patients. The circulating BP antibodies can be detected by indirect immunofluores-cence in patients' serum and their target antigens including BP320 and BP180 are located at the basement membrane zone .BPAGs which are located at the lamina lucida and hemidesmosome in BMZ are produced and secreted by the basal cells in the epidermis, including the main antigen BP230 and the minor antigen BP180 which are critically important to the BP pathogenesis.The exact pathogenesis of the BP is not very clear until now, but we all generally think that the reaction of the BPAGs with the BPABs which can activated the complements at the BMZ has caused this kind of disease. The activation of the complements at the BMZ has caused mast cells and neutrophils to infiltrate in the spot where BPAGs and BPABs react with each other. The cytokines including eosinophil chemokine released by the mast cell eventually lead to the formation of the subepidermal vesicles and bullas. Histopatholoy and immunopatholo-gy are very important to the diagnosis and differential diagnosis of the bullous pemphigoid, but the biopsy can bring great bitterness to the patients.Therefore, the purpose of the study is to develop a simple, fast and non -invasive method for the immunopathological diagnosis of bullous pemphigoid u-sing plucked hair of the patients by direct immunoflurescence.Materials and Methods1. Materials1) Cases; 23 bullous pemphigoid patients including 17 males and 6 females from No. 1 Hospital of China Medical University were definitely diagnosed through typical clinical symptoms, histopathology and immunopathology.2) Main reagents; FITC - binding sheep - anti human IgG antibody ( A-merican SIGMA Corporation).2. MethodsThe bullous pemphigoid antibodies from 23 cases of bullous pemphigoid patients were examined by direct immunofluorescent staining of the residual follicles of plucked hair. Hair from healthy people and pemphigus patients were used as controls.Results20 of 23 bullous pemphigoid patients are positive with linear deposits of IgG of bullous pemphigoid antibodies in the plucked hair follicles. The positive rate is about 87. 0% , 3 of 23 patients negative. Linear deposits of IgG antibodies can be observed in the layer between the outer root sheath and dermal sheath from the hair infundibulum to hair bulb in bullous pemphigoid patients, but such pattern was not seen in healthy controls and pemphigus.ConclusionsBecause of plenty of blood flowing through the scalp, the bullous pemphigoid antibodies IgG may deposit at the corresponding target antigens along the BMZ of the hair follicles in the scalp. The examination of IgG pemphigoid antibodies by direct immunofluorescence in the residual follicles of plucked hair may be a convenient, sensitive and specific method for the diagnosis of bullous pem-phigiod.