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Immunofluorescence on salt-split skin for the diagnosis of epidermolysis bullosa acquisita.

Epidermolysis bullosa acquisita (EBA) is a severe chronic subepidermal bullous disease that has been described in the medical literature since the 19th century.1,2Like most primary blistering diseases, EBA is decidedly rare. However, EBA may be more common than previously appreciated, especially if one includes all subepidermal blistering disorders associated with autoantibodies to type VII (anchoring fibril) collagen.3,4 The full clinical spectrum of EBA is not known. The most well-known presentation of EBA is a noninflammatory, mechanobullous disease reminiscent of porphyria cutanea tarda or dystrophic forms of hereditary EB. These patients are plagued with marked skin fragility and chronic wounds that heal with scarring and milia formation. This "classical" presentation was well documented by Roenigk et al,2who reviewed the world literature through 1971 and added three new cases of EBA. Patients with EBA frequently have significant involvement of their mucosal surfaces, such as the mouth, genitalia, and