Autoimmune Aspects of Three Skin Diseases: Pemphigus, Cutaneous Lupus Erythematosus and Vitiligo1

Summary This paper discusses three skin diseases due to or associated with autoimmunity: pemphigus vulgaris, cutaneous lupus erythematosus and vitiligo. In pemphigus vulgaris there is an autoantibody to an. antigen in. the inter‐epithelial or cell‐wall region of the prickle‐cell layer of stratified squamous epithelium. The site of reaction of this antibody corresponds with the acantholytic lesions of pemphigus vulgaris. In cutaneous lupus erythematosus antinuclear antibody may enter mildly damaged cells of stratified squamous epithelium and react with the cell nucleus. This results in the formation and deposition of antigen‐antibody complexes at the dermal‐epidermal junction, and these complexes may be distributed systemically and trapped in the kidney, causing glomerulonephritis. Thus the skin could be a site of primary importance in the genesis of the systemic lesions of lupus erythematosus. Vitiligo is known to coexist with a group of diseases which are clinically and serologically interrelated and are attributable to autoimmunity: pernicious anaemia, Hashimoto's thyroiditis and thyrotoxicosis, and adrenal atrophy. Striking clinical examples of these associations exist, but no specific autoantibody system is demonstrable. Hence the case for autoimmunity in vitiligo rests only on “guilt by association”.