Role of cell-mediated immune reaction in blister formation of bullous pemphigoid.

In patients with bullous pemphigoid (BP), early lesions appear as exudative erythematous patches. Histologically, the inflammatory infiltrate is composed mainly of mononuclear cells (MNCs) in the erythematous lesion, although eosinophils and neutrophils are also present. The MNCs are predominantly helper/inducer T cells even in the bullous lesions. Some of the MNCs infiltrated were stained in cytoplasm by antihuman gamma-interferon (IFN-gamma) monoclonal antibody (MoAb) immunohistologically. These infiltrates are considered to produce IFN-gamma. In the bullous fluids of early BP lesions, high levels of IFN-gamma are detected by radioimmunoassay using antihuman IFN-gamma MoAb. The results suggest that infiltrating lymphocytes are stimulated immunologically in BP bullous lesions. Cell-mediated immune reaction as well as autoantibody to the basement membrane zone may also play an important role in blister formation in BP.