PMC3617966_01
LP-like lesions on the extremities (a). Vesicles with erythema on the right sole (b). Lace-like lesion on the buccal mucosa (c). After combination therapy with CyA and PSL, these skin and mucosal lesions remarkably improved (d-f).
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F1
On physical examination, flat-topped, polygonal, violaceous-colored plaques or papules were seen on the extremities, and some papules were accompanied by small vesicles or erosions on top of them (fig. 1a). Tense vesicles were also seen on the soles (fig. 1b). Lace-like, reticulated, whitish lesions were seen on the buccal mucosa (fig. 1c). Three months later, the anti-BP180 antibody titer index dropped to 14, and both the skin lesions (fig. 1d, e) and oral enanthemata (fig. 1f) markedly improved.
Histopathological findings of the LP-like (a; x40) and blistering (b; x100) skin lesions. The result of direct immunofluorescence for IgG (c; x100) and C3 (d; x100). The result of indirect immunofluorescence on 1 M NaCl split skin for IgG antibodies (e; x200).
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F2
Histopathological examination of the skin biopsy from the papular lesion on the right leg revealed hyperkeratosis, hypergranulosis, acanthosis and liquefaction degeneration in the epidermis and band-like infiltration of lymphocytes in the upper dermis, which was compatible with LP (fig. 2a). A further biopsy specimen from the right sole showed subepidermal blister formation with moderate inflammatory infiltrates (fig. 2b). IgG (fig. 2c) and C3 (fig. 2d) deposition on the basement membrane zone. Indirect immunofluorescence on 1 M NaCl split skin detected IgG reactivity with the epidermal side (fig. 2e).