Ultrastructural Sites of Blister Formation in Dermatitis Herpetiformis: Report of a Case and Retrospective Electron Microscopy Using Routine Histologic Preparations

Abstract

AbstractElectron microscopy of the skin lesions of a patient with the classical type of dermatitis herpetiformis (DH), showing granular IgA deposits beneath the epidermis and gluten‐sensitive enteropathy, revealed that the initial changes of the vesicular or blister formation are neutrophilic invasion above the basal lamina and consequent degeneration of the basal cells. Retrospective electron microscopic studies using the refixation‐reembedding method performed on four previous cases of classical DH revealed the coexistence of degeneration of the basal cells and dermal vacuolization in two cases, blister formation above the basal lamina in one case, and blister formation in the uppermost dermis with basal lamina remaining along the blister roof in one case. The infiltrating inflammatory cells in the skin of classical type of DH seem to injure the epidermal‐dermal junction, including the basal cells and the uppermost dermis, to initiate the blister or vesicular formation.