Intercellular antibodies in blood and epidermis

Antibodies directed against intercellular epithelial structures (ICE) have been important in the diagnosis of pemphigus vulgaris. Our study of thirty-seven patients with maculopapular eruptions following therapy with penicillins, clearly indicate that antibodies morphologically indistinguishable from those found by standard techniques in pemphigus vulgaris are also found here. Indirect staining by fluorescence and horse-radish peroxidase indicated localization against ICE identical to that seen in pemphigus, in about half the patients. Direct staining of skin from two penicillin-allergic patients revealed similar staining in the familiar pattern, which closely resembles the network of lines in giraffe skin. Detection of circulating antibody directed against a component of epithelium introduces new insight into the pathophysiology of maculopapular penicillin eruptions, although further work is required to show what the exact relationship is to pemphigus vulgaris, the potentially fatal skin disease.