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A 35-year-old Japanese woman had recurrent, pruritic, vesicular lesions on the face, neck and upper back as well as erosive lesions of the oral cavity and genitalia. The skin and mucosal lesions healed without scarring upon the systemic administration of corticosteroid and azathioprine. Direct immunofluorescence revealed linear deposits of IgG, IgA and C3 at the cutaneous basement membrane zone. Indirect immunofluorescence on 1 M NaCl-split human skin sections demonstrated that the patient’s IgG antibodies reacted with the dermal side of the split, while IgA antibodies weakly reacted with the epidermal side. By immunoblot analyses, the patient’s serum reacted with the NC1 domain of type VII collagen as well as both the α₃- and β₃-subunits of laminin 5. We regarded our case as a nonscarring subepidermal blistering disease with autoantibodies to both type VII collagen and two different subunits of laminin 5. Such a case has not been previously reported.

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Sir, Many patients with atopic dermatitis have widespread dry skin, which has a disturbed water barrier function (1). Stratum corneum lipids play an important role here. Recently, various authors have reported that dry skin in people with atopic dermatitis shows a marked reduction in ceramides (2, 3). We measured the ceramides in dry and normal skin of patients with atopic dermatitis and compared the results with those for normal individuals. MATERIALS AND METHODSA total of 44 patients (15 males and 29 females) with mild atopic dermatitis were included in this study. They ranged in age from 15 to 31 years. All patients ful¢lled the diagnostic criteria of Hani¢n & Rajka (4). In 14 patients, the volar surface of the forearm showed dry and rough skin that exhibited white dermographism. In 30 patients, the £exor forearm showed normal-appearing smooth skin that revealed red dermographism. Patients with ichthyosis vulgaris were excluded. No preparations were applied to the forearm for 4 weeks preceding the investigation. All the measurements were made on the £exor surface of the mid forearm. Twenty-¢ve age-matched healthy subjects were included as controls. The study details were discussed in full with each subject and informed consent for participation was obtained.Previous studies (5, 6) have demonstrated that red dermographism commonly occurs in areas of normal-appearing skin of patients with atopic dermatitis, whilst white dermographism consistently occurs in areas of dry skin in these patients. In the present study, therefore, dry skin was de¢ned as a rough, ¢nely scaling, non-in£amed surface that showed white dermographism. Normal skin was de¢ned as a smooth, clear skin that showed red dermographism.Skin surface lipids were collected from the £exor mid forearm using the cup method (7).The lipid extracts were weighed and determination of lipid classes was accomplished using thin-layer chromatography separation. The thin-layer chromatograms were developed twice with chloroform/ methanol/acetic acid (190 : 9 : 1 by volume) for separation of six ceramide fractions (2).Data were expressed as mean¡SD. Student's t-test was employed for statistical analysis. A p value of 0.05 was accepted as statistically signi¢cant.