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Background and Design: Several articles have described patients with pemphigus who showed a transition from pemphigus vulgaris (PV) to pemphigus foliaceus (PF) or vice versa. However, there have been no adequate reports in the literature on the association between transition in disease type and change in autoantibody reactivity against the pemphigus antigens. We investigated the antigen profiles of the serum samples obtained from two patients with pemphigus who were demonstrated to shift from PV to PF with evidence from clinical, histologic, and immunohistologic findings. Western blot technique was performed using normal human epidermal extracts as an antigen source. Results: The serum samples of both cases at the PV stage reacted with the 130-kd antigen and the serum samples at the PF stage reacted with the 150-kd antigen. Accordingly, the dermatologic, histologic, and immunohistologic findings before and after the transition from PV to PF were clearly related to changes in the serum reactivity with the pemphigus antigens. Conclusions: This was the first investigation completely demonstrating changes in antigen profiles at the molecular level consistent with transition from the PV to the PF form of the disease. Moreover, the findings of this study confirmed the existence of a close correlation between the 130- and the 150-kd antigens, with the onset of each form of the disease. (Arch Dermatol. 1994;130:1534-1538)

We investigated gelatinolytic enzymes derived from cultured human keratinocytes. Using a zymograph, we detected 92 kDa and 72 kDa gelatinases as major components and 83 kDa as a minor component from a conditioned cultured medium (BSL-K110, Kyokutoseiyaku Co.) of keratinocytes. After several passages, the 72 kDa band disappeared, and the 83 kDa band became dominant in another conditioned culture medium (K-GM, Kurashikibouseki Co.); these keratinocytes had a relatively differentiated appearance. These results suggest that some mechanism may regulate the secretion of selected types of gelatinase from keratinocytes under different conditions.

Background: Eosinophilic pustular folliculitis is a distinctive dermatosis that was first described in Japan. Although the histopathologic feature of eosinophilic pustular folliculitis is characterized by follicular infiltrates with numerous eosinophils, its pathophysiology remains unclear. The lesional skin of five patients with eosinophilic pustular folliculitis was examined using several monoclonal antibodies including a variety of anti-leukocyte adhesion molecules: endothelial cell adhesion molecule 1, vascular cell adhesion molecule 1, and intercellular adhesion molecule 1, by means of immunohistochemical techniques. Observation: Intercellular adhesion molecule 1 expression by keratinocytes was observed on follicular epithelium, but not on epidermis. The migration of eosinophils and lymphocytes, which were intensely positive for anti-lymphocyte function-associated antigen 1, was limited to follicular epithelium. Endothelial cell adhesion molecule 1 and vascular cell adhesion molecule 1 expression of vascular endothelium was more often observed around hair follicles. There was no reactivity for interleukin 8 in follicular epithelium. Conclusions: These findings may explain the selective migration of eosinophils and lymphocytes to the hair follicles in eosinophilic pustular folliculitis. ( Arch Dermatol. 1993;129:1015-1019)

To the Editor.— The concept of nodular cutaneous mucinosis with lupus erythematosus (LE) has been proposed as a distinct variant of cutaneous LE because of its specific clinical features and the histologic evidence of mucin deposition. 1-5 Recently, we examined two patients with systemic LE (SLE) in whom large indurated plaquelike lesions developed that measured 10 to 20 cm in diameter on the trunk. These lesions also had a histologically abundant mucin deposition throughout the dermis. The characteristic large plaquelike skin lesions reported here should be classified as a new clinical variant of cutaneous LE. Report of Cases.—Case 1.— A 60-year-old Japanese man with nephrotic syndrome associated with SLE was referred to our department with a large plaquelike skin lesion with a hard cutaneous induration about 10 to 20 cm in diameter on his lower back (Fig 1). The onset of the lesion was unknown and was not preceded by

• We describe a 7-year-old girl with recurrent pruritic vesiculopustular lesions involving the trunk, extremities, face, and oral mucosa. Histopathologic examination revealed intraepidermal bullae containing neutrophils and eosinophils, and direct immunofluorescence test showed the deposition of IgA in the intercellular space of the epidermis. Circulating IgA anti-intercellular antibodies were also detected by indirect immunofluorescence test. Immunofluorescence studies using monoclonal antibodies to human IgA subclasses showed that these IgA antibodies belonged to IgA 1 . Antisera against J chain and secretory component did not show any specific intercellular staining. Surface IgA + -B cells were transiently increased in the peripheral blood during the active stage of the disease. These results indicated the extragut origin of these IgA antibodies. Dapsone therapy was shown to be very effective. ( Arch Dermatol. 1991;127:221-224)

A 6-year-old boy (Sudanese) with Kerion celsi due to Microsporum audouinii was reported. He was a member of the embassy staff's family and the causative fungus was thought to be brought from abroad. Since previous reports of M. audouinii in Japan lacked precise description of mycologic characteristics, our report was considered to be the first case of Kerion celsi due to M. audouinii.

In order to characterize the pemphigus antigen(s), the binding sites of phytohemagglutinins and pemphigus antibody were studied by the combined use of fluorescein-labelled Concanavalin A (Con A-FITC), Phytohemagglutinin-P-FITC (PHA-P-FITC) and pemphigus antibody. Reciprocal blocking test of PHA-P and pemphigus antibody revealed that the binding sites of PHA-P and pemphigus antibody were independent, whereas those of Con A and pemphigus antibody were very closely related though not identical. Pemphigus skin with deposition of IgG or with presumable saturation of the binding sites with high-titred antibody showed capability to Con A binding. Treatment of normal skin sections with Hyaluronidase or Neuraminidase did not supply any clue to the histochemical analysis of pemphigus antigen(s), since the binding sites of pemphigus antibody were destroyed in the buffer, prior to the enzyme digestion. These results suggested that the binding sites of pemphigus antibody in the intercellular areas consist, at least, of carbohydrates or glycoproteins that contain alpha-methyl-D-mannoside or alpha-methyl-D-glucoside.