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A multistep immunochemical method was developed for light and electron microscopy utilizing horseradish peroxidase as an immunologically bound marker. The method was applied to studies of in vivo bound IgG in bullous pemphigoid skin and of circulating antibasement membrane antibodies using rhesus esophagus as substrate. The immunocytochemical chain employed consisted of sequential binding of goat antihuman IgG, rabbit antigoat IgG, goat antihorseradish peroxidase antibody, and horseradish peroxidase. The sites of the latter were revealed cytochemically. At the light microscope level, results closely paralleled those obtained with regular immunofluorescence. With the electron microscope, IgG deposits were shown to be confined to the basal lamina and lamina lucida including the basilar surface of basal cells. Immunoglobulin deposits in bullous pemphigoid appear to be a true basal lamina phenomenon. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to an article on the frequent occurrences of the image of the physician in world literature by Solomon Posen, published in the September 1992 issue.

Presents a response by H. Pehamberger, K. Konrad and K. Holubar to a letter to the editor about his article on dermatitis herpetiformis and IgA.

It is well established that suprabasal acantholysis can be produced in tissue culture of normal human skin in the presence of pemphigus IgG autoantibody. In this study, bullous pemphigoid, herpes gestationis and linear dermatitis herpetiformis anti-basement membrane zone antibodies failed to produce dermoepidermal separation in a tissue culture model in spite of the presence of complement. The binding of the antibodies was demonstrated by immunofluorescence and immunoelectron microscopy; ultrastructurally, identical binding sites of anti-basement membrane zone antibodies could be demonstrated in vitro, as has been observed in vivo previously. Tissue culture is a suitable model for studying the binding sites of circulating anti-basement membrane zone antibodies but the functional activity (blister formation) of these antibodies cannot be assessed thereby. [ABSTRACT FROM AUTHOR]

Albert Reder von Schellmann (1826-1904) was an important syphilidologist of the Vienna Medical School in the second half of the nineteenth century. He went in for the dualistic concept of the origin of syphilis and ulcer caused by soft chancre. In 1870 - Reder became head of a third dermato-syphilidologic department in the "Josephinum" in Vienna, where military surgeons got their medical education. At the same time the two full professorships of dermatosyphilidology in the Vienna General Hospital were held by Ferdinand von Hebra (1816-1880) and Carl Ludwig Sigmund von Ilanor (1810-1883).

It has previously been shown tha UV irradiation can give rise to fresh skin lesions in the uninvolved skin of patients with pemphigus. In this study no increase of acantholytic activity was found in an organ culture model system for pemphigus in vitro, after in vitro and in vivo irradiation under various experimental conditions. By immunofluorescence no increase in IgG binding in irradiated specimens was observed. From these in vitro findings, which contrast the effect of UV light in pemphigus in vivo, it may be concluded that the circulatory system of the skin plays a major role in the photo induction of acantholysis in pemphigus.

A multistep immunocytochemical method utilizing horseradish peroxidase as an immunologically bound marker was used to detect and localize IgA deposits in skin of patients with dermatitis herpetiformis at the ultrastructural level. IgA was found in the upper papillary dermis forming irregular aggregates in seemingly haphazard distribution. These aggregates were associated with microfibrillar bundles and with the microfibrillar component of the elastic tissue. IgA was also detected on anchoring fibrils, but showed no topical relationship to the basal lamina which was always spared. This finding indicates that basal lamina components do not serve as target sites for the immunologic reaction occurring in dermatitis herpetiformis. The selective affinity of IgA deposits to microbfibrillar bundles may be relevant to the hypothesis that the skin pathology in dermatitis herpetiformis is caused by circulating gluten-antigluten complexes, trapped in the skin by reticulin-bound antireticulin antibodies which cross-react with gluten.

IgA deposits were observed by direct immunofluorescence in linear distribution along the basement membrane zone in a case of dermatitis herpetiformis (Duhring). In addition, in the serum of the same patient circulating IgA antibasement membrane zone antibodies were detected by indirect immunofluorescence, utilizing normal human skin and monkey esophagus as substrates. The ultrastructural localization of in vivo-bound IgA and circulating IgA antibasement membrane zone antibodies fixed to substrate tissue in vitro was found to be in the uppermost strata of the dermis below the basal lamina.

Linear deposits of both IgA and C3 were found along the BMZ (by direct IF), and band-like IgA deposits directly below the basal lamina (by HRP-anti-HRP electron microscopy), in a case of clinically typical DH. No circulating antibodies could be detected.

During a century of development of investigative dermatology (1880s-1980s), the center of gravity in the field has moved west, from Europe to North America. The foundation of the American Dermatological Association, the discipline's oldest national society, has forshadowed this development. The foundation of the Society for Investigative Dermatology (and also of the American Academy of Dermatology), have marked the height of this shift. The foundation of the European Society for Dermatological Research and its participation in the Journal of Investigative Dermatology, as a junior partner, concludes this process, and at the same time, illustrates the change that has taken place. The following article attempts to outline some of the pathways along which this shift has occurred, as seen from a central European perspective.

IgG and C3 deposits were observed in the basement membrane zone in a case with herpes gestationis. In addition, circulating IgG anti-basement membrane antibodies were found. Electron microscopic immunocytochemical investigations, performed with a peroxidase-antiperoxidase sandwich technique, revealed the in vivo-bound IgG to be localized at the epidermal basal lamina and to exhibit a distribution pattern which is identical to that reported for bullous pemphigoid.