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Bullous pemphigoid causes tense bullae, usually, but not always, on a pink wheal-like base. The bullae arise after IgG antibodies bind to BP180, a transmembranous collagenous protein involved in the adherence of basal cells to the basement membrane zone. Components of complement, generated after activation by the antigen–antibody reaction, attract eosinophils, causing them to attach to the basement membrane zone, where they induce dermal–epidermal separation. This mechanism makes sense, but sometimes bullae arise on relatively normal skin without much inflammation and devoid of eosinophils. Perhaps the antibody reaction somehow reduces the amount of BP180, thereby weakening the attachment directly.
In a recent study, researchers incubated ke…