Here, we’ll take a look at a very
important diagnostic image or images
in which I will be comparing pemphigus
vulgaris to bullous pemphigoid.
You want to pay a special attention
to this page and to the images
because this is the one in which
it’s going to summarize everything
that you need to know between the
differences between the two diseases.
in general, it’s called
But in other words, it’s a fact
that you’re forming these blisters,
either due to pemphigus
vulgaris or bullous pemphigoid.
And the diagnostic tool that we’re using
here is called immunofluorescence.
The last time we’ve seen the term or
the diagnostic tool immunofluorescence
was when we’re dealing with a type 3
hypersensitivity in renal pathology
in which we were then identifying
your immune complexes,
or maybe perhaps your immunoglobulins
in the basal membrane, right?
For example, if you find immune
complex in your basement membrane,
we call that lumpy bumpy our granular
pattern of immunofluorescence.
So are we clear?
Whereas, if it’s Goodpasture,
then that IgG that was found in the
basement membrane was of a linear pattern,
Now, with the premise in mind,
what are we looking for?
Now, the picture on the left,
take a look at these
Beautifully highlighted at
the dermoepidermal junction.
Stop and think and then answer.
We’re at the
The first question,
what bridge is this?
What’s the name of this
protein or bridge that keeps
the anchor between the
Hemi-desmosome is going to appear
immunofluorescent, that makes no sense,
because it’s not
So, that means now, we
have a pathology because
the dermoepidermal junction
is beautifully delineated.
You see that?
And so therefore, an IgG is
attacking the hemi-desmosome.
Bullous pemphigoid, very good.
Tell me about the blister.
Tight or ruptured?
Large or small?
Superficial or deeper?
What about the right?
On the right, you’ll notice
that there’s absolutely no
linear pattern of your immunofluorescence.
it is the IgG which is
then attacking the bridge
between or the protein between
your keratinocytes, right?
And so therefore, this is
referred to as being your
If this is being attacked by IgG,
then what happens to your skin?
It comes off,
and we call this acantholysis,
The one the left, bullous pemphigoid.
On the right,
Which one has an increased
risk of mortality?
The vulgar one, the
Both are type 2
and we talked about which
proteins are being attacked.