An ultrastructural study of pemphigoid vegetans, characterizing the possible mechanism of vegetation

Abstract

Ultrastructural changes in the skin lesions of pemphigoid vegetans were observed by transmission electron microscopy. Two significant changes were recognized at the vegetating site: (1) The basal lamina was sometimes interrupted and detached from the basal cells, protruding into the dermis to form folds. In the basal cells, hemidesmosomes were not decreased in number but tonofilament bundles were fewer than normal. Occasionally, basal cell processes extended beyond the basal lamina through its gap. These features resembled the epidermal growth factor-induced morphological changes of cultured skin. It was suspected that the abnormal attachment of the basal lamina to the basal cell was associated with keratinocyte proliferation. (2) Mast cells were encountered in the epidermis abutting on the basal lamina. It is uncommon to find mast cells in the epidermis. Mast cells in the epidermis were reported at the erythematous regions which were adjacent to the bullae of bullous pemphigoid, and were thought to have an important role in forming blisters. It was suggested that early changes in blister formation occur at the vegetating site.