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Using the enzyme-linked immunosorbent assay (ELISA), we detected antibodies to interstitial (type I) and basement membrane (type IV) collagens in the sera of patients with scleroderma (systemic sclerosis). Antibodies against type IV collagen were found in significant levels in these patients and correlated with the presence of abnormal pulmonary diffusion capacity. Levels of antibodies to type I collagens also correlated significantly with pulmonary diffusion capacity. Absorption of sera with type I or type IV collagens before analysis in the ELISA eliminated reactivity in an antigen-specific pattern, indicating that these antibodies reacted with determinants specific for either type I or type IV collagens. The removal of immune complexes by ultracentrifugation had no effect on serum antibody levels. Autoantibo-

Bleomycin sulfate, administered parenterally alone and in combination with vinblastine sulfate for treatment of various neoplastic diseases, has been associated with the development of Raynaud's phenomenon (1-5). Additionally. bleomycin therapy has been associated with a number of varied skin reactions, including hyperpigmentation, sclerosis, gangrene, indurated plaques, and hyperpigmented nodules (6).Several recent reports have described the use of intralesional injections of bleomycin sulfate for treatment of cutaneous warts, and have noted no complications (7-10). We describe a patient who received this treatment and subsequently developed Raynaud's phenomenon, which was limited to the injected digit.Case report. A 23-year-old, healthy woman sought medical treatment for a wart located over the palmar aspect of the proximal interphalangeal joint (PIP) of the right index finger. An initial, unsuccessful, attempt at electrocautery was followed by multiple local liquid nitrogen treatments over the ensuing 5 months; each treatment was unsuccessful. Four months later, after regrowth of the wart, the patient received a single injection of bleomycin sulfate (1 mg)

Although nailfold capillary abnormalities associated with connective tissue disease (CTD) have been studied by direct in vivo microscopy, little is known of the underlying histology and morphology of this tissue. This report summarizes light microscopic study of glycolmethacrylate embedded nailfold biopsies from 13 CTD patients (9 scleroderma, 2 CREST, 2 undifferentiated CTD), 2 subjects with Raynaud's phenomenon alone, and 9 normal volunteers of similar age and sex distribution. The most striking and consistent finding was the presence of globular, eosinophilic, PAS‐positive deposits in the cuticles of 14 of 15 patients and none of the controls. This material, identified by immunofluo‐rescent staining as serum protein exudates, was associated with pronounced parakeratosis and elevated epithelial mitotic activity. Capillary ectasia with thinning of the basement membrane was often present in CTD biopsies. Occasional signs of endothelial swelling and proliferation were encountered in both populations. Inflammatory changes were rarely seen. In quantitative comparison with control tissues, the superficial dermis from CTD patients contained significantly fewer capillaries, cutaneous nerve bundles, and interstitial fibroblasts per unit area and fewer papillary capillaries per unit of epidermal length. Measures of capillary density in sectioned tissue correlated well with the results of in vivo microscopic examination.

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