Chronic Bullous Dermatosis of Childhood-Reply

In Reply.— We did not intend to imply that the finding of linear IgA at the dermoepidermal junction on direct immunofluorescence is diagnostic of chronic bullous dermatosis of childhood. In bullous pemphigoid, IgA can be found in a similar pattern, but IgG is the predominant immunoglobulin present, and the morphologic characteristic of the band is distinctive. In dermatitis herpetiformis, IgA can also be found along the dermoepidermal junction but is uncommon; such a patient was described recently by Yaoita et al.1The characteristic immunofluorescent finding in dermatitis herpetiformis is deposition of IgA in the dermal papillae and/or discrete granular deposits at the dermoepidermal junction, especially prominent in the dermal papillae. It is becoming apparent that children who have a chronic eruption of large blisters with rosette formation and figúrate erythematous plaques can have deposition of IgA along the dermoepidermal junction. All of the cases with positive immunofluorescent findings reported to date2-5have had this finding, including an additional case reported recently.6