The binding of autoantibodies is postulated to result in a cascade of biochemical intracellular events that eventuates in the loss of desmosome function. Histopathology Intraepidermal, superficial blistering, usually at the granular layer or just below it. Acantholysis may occur in the blister floor or roof. Follicular hyperkeratosis with acantholysis and dyskeratosis of granular layer often is marked in later stages. Immunoelectron microscopy IgG and C3 deposits are seen localized to the epidermal cell membranes and the upper dermis.
Perilesional skin is tested for immunofluoresecence studies.
Superficial bullae usually are within the granular layer or just below it. Old lesions may have follicular hyperkeratosis with acantholysis and dyskeratosis of the granular layer. As in all photosensitive disorders, patient education on the use of sunscreens, protective clothing, and sun-smart behaviors is a cornerstone of therapy. Topical therapy - Topical corticosteroids are useful for patients with limited diseases or as an adjunct to systemic therapy. Selection of the appropriate topical steroid strength and vehicle depends on the body site, age of the patient, and the potential for steroid side effects.