Indian Journal of Dermatology
  Publication of IADVL, WB
  Official organ of AADV
Indexed with Science Citation Index (E) , Web of Science and PubMed
 
Users online: 657  
Home About  Editorial Board  Current Issue Archives Online Early Coming Soon Guidelines Subscriptions  e-Alerts    Login  
    Small font sizeDefault font sizeIncrease font size Print this page Email this page


 
Table of Contents 
CORRESPONDENCE
Year : 2012  |  Volume : 57  |  Issue : 5  |  Page : 417-418
Authors' Reply


Department of DVL, Kamineni Institute of Medical Sciences, Narketpally, Nalgonda District, Andhra Pradesh, India

Date of Web Publication3-Sep-2012

Correspondence Address:
Haneef Nayeem Sadath
Department of DVL, Kamineni Institute of Medical Sciences, Narketpally, Nalgonda District, Andhra Pradesh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


Rights and PermissionsRights and Permissions



How to cite this article:
Sadath HN, Ramachandra S, Kumar MA, Srujana L. Authors' Reply. Indian J Dermatol 2012;57:417-8

How to cite this URL:
Sadath HN, Ramachandra S, Kumar MA, Srujana L. Authors' Reply. Indian J Dermatol [serial online] 2012 [cited 2019 Sep 18];57:417-8. Available from: http://www.e-ijd.org/text.asp?2012/57/5/417/100504


Sir,

We thank you for your great interest in our article. [1] We agree with your view that immunofluorescence pattern is very important in making a diagnosis of linear IgA disease (LAD) in both children and adults. There is no problem in labeling cases with typical linear deposition of IgA at the basement membrane zone (BMZ) as LAD. However, confusion arises when cases have a characteristic 'cluster of jewels appearance' or 'string of pearls appearance' of lesions but show predominant deposition of other immunoglobulins than IgA at BMZ. Ignoring this important clinical sign, especially among childhood cases, and basing diagnosis on immunofluorescence only would mean that we could potentially under diagnose many cases of chronic bullous disease of childhood. [2] Labeling such cases as LAD despite immunofluorescence not showing predominant IgA will make it a misnomer. Numerous such cases have been reported with a multitude of terms like mixed immunobullous disease, linear IgG/IgA disease, linear IgA/IgG disease, and so on, without having much difference from the classical 'chronic bullous disease of childhood' in therapeutic response to dapsone or prognosis. [3] Hence an umbrella term deeply entrenched in the dermatological literature, like 'chronic bullous disease of childhood', may be preferred.

The term 'chronic' in the nomenclature of this entity is not completely misplaced as the condition usually lasts for as long as 3-8 years and several cases persisting well into adulthood have been reported. [4] However, we agree with your concern that this term may cause anxiety for the patients or their parents.

Peterson et al. described a case of linear IgA bullous disease but initially presenting with histopathologic and immunofluorescent findings consistent with bullous pemphigoid. [5] Initial direct immunofluorescence showed a predominance of linear IgG at the basement membrane zone (BMZ) of perilesional skin, and indirect immunofluorescence showed a low titer circulating IgG anti-BMZ antibody. Repeat studies 3 years later revealed a predominance of linear IgA immune deposits at the BMZ and no circulating anti-BMZ antibody. Further, immunoelectron microscopy and other studies confirmed the diagnosis of LAD. Patient responded well to dapsone. This case demonstrates that direct or even indirect immunofluorescent findings, when considered alone without clinical correlation, can be misleading.

 
   References Top

1.Haneef NS, Ramachandra S, Metta AK, Srujana L. Chronic bullous disease of childhood with IgG predominance: What is the locus standi? Indian J Dermatol 2012;57:285-7.  Back to cited text no. 1
    
2.Thappa DM, Jeevankumar B. Chronic bullous dermatosis of childhood. Postgrad Med J 2003;79:437.  Back to cited text no. 2
[PUBMED]    
3.Powell J, Kirtschig G, Allen J, Dean D, Wojnarowska F. Mixed immunobullous disease of childhood: A good response to antimicrobials. Br J Dermatol 2001;144:769-74.  Back to cited text no. 3
[PUBMED]    
4.Burge S, Wojnarowska F, Marsden A. Chronic bullous dermatosis of childhood persisting into adulthood. Pediatr Dermatol 1988;5:246-9.  Back to cited text no. 4
[PUBMED]    
5.Petersen MJ, Gammon WR, Briggaman RA. A case of linear IgA disease presenting initially with IgG immune deposits. J Am Acad Dermatol 1986;14:1014-9.  Back to cited text no. 5
[PUBMED]    




 

Top
Print this article  Email this article
 
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (341 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    References

 Article Access Statistics
    Viewed1040    
    Printed46    
    Emailed0    
    PDF Downloaded42    
    Comments [Add]    

Recommend this journal