The clinical transition between pemphigus foliaceus and pemphigus vulgariscorrelates well with the changes in autoantibody profile assessed by an enzyme-linked immunosorbent assay

Background There are a number of reports of pemphigus with clinical shiftin g between pemphigus foliaceus (PF) and pemphigus vulgaris (PV). On the othe r hand, a novel enzyme-linked immunosorbent assay (ELISA) against recombina nt baculoproteins of desmoglein 1 (Dsg1) (PF antigen) and Dsg3 (PV antigen) has been established and found to be extremely sensitive and specific. Objectives To characterize the change in the antibody profiles in a series of pemphigus cases with mixed features of PF and PV by various methods, inc luding the novel ELISA. Patients/methods Sera were obtained from eight cases undergoing a shift bet ween PF and PV and three cases of coexistent PF and PV. The autoantigens we re analysed by ELISA, as well as by immunofluorescence using normal human s kin sections and immunoblotting using normal human epidermal extracts. Results The results of the ELISA, immunofluorescence and immunoblotting stu dies showed that the transition between PF and PV correlates well with the changes of autoantibodies against either Dsg1 or Dsg3. Conclusions The clinical phenotype at each stage is defined by the anti-Dsg antibody profile in the serum of these pemphigus patients showing mixed fe atures of PF and PV. In addition, ELISA using recombinant baculoproteins wa s particularly useful in distinguishing PF and PV.