Dermatopathology

Bullous Pemphigoid

Bullous pemphigoid is an autoimmune vesiculobullous disorder whereby the pathogenesis is caused by autoantibodies to components of the basement membrane of the skin namely BP antigen 180 (type XVII collagen and the most frequent antigenic target) and BP antigen 230 (component of the hemidesmosome).

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Slide 1: A 90 year old male patient presents with blisters on the trunk, arms, skin, and scalp. There is frank detachment of the epidermis from the dermis in the biopsy specimen.
Slide 2: The separation of the epidermis from the dermis occurs at a subepithelial level reflecting an autoimmune response to hemidesmosomal proteins.
Slide 3: The epidermis has undergone degenerative changes, and the blister cavity contains eosinophils and lymphocytes.
Slide 4: Assessing compliment deposition on paraffin embedded formalin fixed tissue can be used as a diagnostic adjunct in the assessment of inflammatory dermatoses. Homogenous linear C3d, C4d, and C5b-9 along the epidermal-dermal junction is observed. This pattern corresponds with a positive linear basement membrane zone DIF profile for IgG and C3. This photograph depicts C4d deposition.
Slide 5: Assessing compliment deposition on paraffin embedded formalin fixed tissue can be used as a diagnostic adjunct in the assessment of inflammatory dermatoses. Homogenous linear C3d, C4d, and C5b-9 along the epidermal-dermal junction is observed. This pattern corresponds with a positive linear basement membrane zone DIF profile for IgG and C3. This photograph depicts C5b-9 deposition.
Slide 6: Assessing compliment deposition on paraffin embedded formalin fixed tissue can be used as a diagnostic adjunct in the assessment of inflammatory dermatoses. Homogenous linear C3d, C4d, and C5b-9 along the epidermal-dermal junction is observed. This pattern corresponds with a positive linear basement membrane zone DIF profile for IgG and C3. This photograph depicts C3d deposition.
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