of the skin have many origins, including bacterial, fun-gal, or viral
infections; allergic contact reactions; burns; metabolic disorders; and
immunologically mediated reactions. Some of these have been discussed
previously (eg, herpes simplex and zoster in-fections, contact dermatitis).
Immunologically mediated diseases are autoimmune reactions and represent a
defect of IgM, IgE, IgG, and C3. Some of these conditions are life-threatening;
others become chronic problems.
diagnosis is always made by histologic examination of a biopsy specimen by a
dermatopathologist. A specimen from the blister and surrounding skin demonstrates
acantholysis (ie, sep-aration of
epidermal cells from each other because of damage to or an abnormality of the
intracellular substance). Circulating anti-bodies may be detected by
immunofluorescent studies of the pa-tient‚Äôs serum.