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Bullous Amyloidosis vs Epidermolysis Bullosa Acquisita

John Fredrick Bluhm Ill, MD
JAMA. 1981;245(1):32. doi:10.1001/jama.1981.03310260016016.
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To the Editor.—  In the article by Trump et al (1980;243:1461), the case was referred to as epidermolysis bullosa acquisita rather than bullous amyloidosis; the distinction is more than semantic and should be clarified. Although both are subepidermal bullous diseases, the bullae in epidermolysis bullosa acquisita form through the anchoring fibril region just below the basal lamina unrelated to cutaneous amyloid deposits,1-4 whereas bullous amyloidosis shows separation through the fragile amyloid-laden dermis as demonstrated nicely by Trump et al in their case report.Of those cases referenced by Trump et al, the reports by Sams and Smith and Brauner et al5 are epidermolysis bullosa acquisita associated with visceral amyloidosis in contrast to those of Northover et al and Muller et al that show bullae through cutaneous amyloid deposits and should be called bullous amyloidosis. The distinction was recognized by Brauner et al5 and has been clarified further


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