Bullous pemphigoid. Clinical and immunologic follow-up after successful therapy

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Abstract
Patients (36) with bullous pemphigoid (BP) were periodically evaluated for 4 yr. This study demonstrates that BP may occur in a transient predominantly localized form that remits spontaneously, and most BP patients after successful therapy remain in prolonged clinical remission. All patients with active or recurrent disease had Ig[immunoglobulin]G and/or C3 [complement component 3] basement membrane zone (BMZ) deposition. Serum anti-BMZ antibodies were an inconstant feature. In most instances clinical remission of BP was associated with disappearance of BMZ Ig and C3 deposition and serum BMZ antibodies. Fluorescein-conjugated, anti-human C3 appears to be a more sensitive immunoreagent than antihuman, class specific, Ig antisera in detecting positive BMZ staining in BP. Combined therapy with azathioprine plus prednisone appears to be superior to prednisone alone in the treatment of BP.