In summary, there is a wide range of pathologic alterations in pemphigoid lesions. Frequently, the pathologist is confident of the diagnosis on light microscopy alone. There are sufficiently similar findings in other conditions, however, to justify direct or indirect immunofluorescence or both in every case. This is particularly true as epidermolysis bullosa aquisita is being defined based on immunopathologic criteria and there is recognition of a broadening of the histologic spectrum of this disease, which includes cases that would have previously been designated bullous pemphigoid.
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