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Herpes gestationis (HG) is an uncommon autoimmune bullous disease that appears during pregnancy or in association with trophoblastic tumors. It is characterized by an intensely pruritic vesiculobullous eruption that develops during the later part of pregnancy or during the immediate postpartum period. Direct immunofluorescence reveals linear deposits of C3 along the basement membrane zone in all patients with active disease.1Although it is generally accepted that HG in the mother is not associated with an increased fetal risk, there is a tendency for premature and small-for-gestationalage babies to occur. Only a few studies have specifically addressed this issue. We have studied all patients diagnosed with HG at our Department of Dermatology since direct immunofluorescence became available; the issue of fetal complications was examined. Patients and Methods. All patients with HG seen at the Hospital Clinic, Barcelona, Spain, between February 1972 and November 1994 were included and retrospectively studied. The

Occurrence of bullous disease in patients with chronic lymphocytic leukemia (CLL) leads to a high suspicion of an autoimmune blistering disorder, especially bullous pemphigoid or paraneoplastic pemphigus. However, the possibility of a characteristic vesiculobullous eruption associated with CLL must be kept in mind. 1,2 We report two cases of this rare entity extensively studied by immunohistology. Report of Cases Case 1 . In 1978, a 70-year-old man was diagnosed with CLL and IgM monoclonal gammopathy. In 1982, he had a pruritic blistering eruption consisting of a few infiltrated erythematous plaques, with some of them covered with vesiculae. The coalescence of vesiculae resulted in large tense bullae, several centimeters in diameter ( Figure 1 ). Each plaque was fixed and healed in 3 to 5 days, sometimes leaving hyperpigmentation but no scar or milia. No bullae occurred on normal skin or on the mucosa. The course of the cutaneous disease was characterized by spontaneous

• Reports of pemphigus following ionizing radiation exposure are rare. We report two cases and review the literature regarding this association. Characteristics common to these cases include a prodromal persistent non-specific dermatitic eruption that is often interpreted as radiation dermatitis, and latency of variable duration before the onset of a vesiculobullous eruption that begins at the portal of irradiation. Direct immunofluorescence is positive for intercellular IgG, while indirect immunofluorescence is commonly positive only at low titers; HLA correlations have not been studied. Documentation of clinical course and laboratory confirmation of the diagnosis, including hematoxylin-eosin, direct and indirect immunofluorescence, and HLA determinations (if available), should be recorded to enable further clarification of this entity. ( Arch Dermatol . 1990;126:1319-1323)

Cicatricial pemphigoid is a chronic, scarring, vesiculobullous eruption, with a theoretical autoimmune cause. It is closely related to bullous pemphigoid, yet unlike bullous pemphigoid, no circulating antibodies have been found. We present here a patient with cicatricial pemphigoid with circulating antibodies to the basement membrane zone of the skin, thus giving more evidence for it being an immunologic disease and for rationale for treatment.

REPORT OF A CASE A 60-year-old woman with a three-month history of a mildly pruritic vesiculobullous eruption involving the extensor surfaces of the extremities, abdomen, and sacral region was referred to the Department of Dermatology at University Hospitals, University of Iowa, Iowa City. A diagnosis of bullous pemphigoid had been made by the referring physician on the basis of the initial clinical presentation and histologic findings of a subepidermal split in a lesional skin biopsy specimen. Direct immunofluorescence of perilesional skin had been performed and showed weak, focal C3 and strong continuous fibrinogen at the basement membrane. Initially, the patient showed a good response to 50 mg of prednisone orally once daily. Azathioprine (Imuran) therapy in a dosage of 50 mg twice daily orally was started four weeks before we saw her; after azathioprine therapy was started, the dosage of prednisone was gradually decreased. She did well until the daily

• Six patients with a vesiculobullous eruption of the type described by Brunsting and Perry as benign pemphigoid were studied by direct and indirect immunofluorescence. All six showed linear deposits of IgG but not IgM or IgA at the epidermal-dermal junction. One case also showed C3 deposition and one patient had circulating antibasement membrane zone antibodies in a titer of 1280. These data provide strong evidence that this condition belongs to the cicatricial pemphigoid-bullous pemphigoid spectrum of disease. ( Arch Dermatol 113:1403-1405, 1977)

• A vesiculobullous eruption with clinical and histological features of bullous pemphigoid developed in a 28-year-old woman with proven systemic lupus erythematosus (SLE). Serum of this patient contained elevated titers of antinuclear antibodies but basement membrane antibodies could not be detected at first, though they did appear in blister fluid. Normal monkey skin explants cultured on this patient's sera gave positive direct immunofluorescence (IF) at the basement membrane zone (BMZ) for IgG deposits. The use of tissue culture methods may be helpful because of the capability of this test system to reveal the presence of the antibodies to the BMZ despite the presence of the antinuclear antibodies that appear to interfere with their demonstration in standard indirect IF tests. (Arch Dermatol114:1187-1190, 1978)