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A 60-year-old Japanese man had developed widespread erythemas with bullae on his trunk and extremities. He was diagnosed as having BP on the basis of the skin manifestations, histopathological ¢ndings and the results of immuno£uorescence staining. The serum was found to have an antibody titre of 1:60 on cryostat sections of guinea pig oesophagus substrate, and showed a typical basement membrane zone (BMZ) pattern of IgG and C3 deposits by direct immuno£uorescence. Epidermolysis bullosa acquisita was ruled out by exclusive staining for IgG on the epidermal side of 1 M NaCl-treated split skin substrate revealed by indirect immuno£uorescence. DFPP was attempted because blisters emerged continuously in spite of systemic prednisolone administered at 70 mg/day. DFPP was carried out twice a week, and skin lesions such as erosions and blisters subsided dramatically during the 11 courses of DFPP. We examined the titres of autoantibody and serum levels of IFN-c (enzyme ampli¢ed sensitivity immunoassay; Biosource, Belgium), TNF-a (enzyme-linked immunosorbent assay; Japan Immuno Research Lab., Japan) and IL-6 (chemiluminescent enzyme immunoassay; Fujirebio Inc., Japan) before and after DFPP. Although plasmapheresis has been thought to work by removing pathogenic autoantibodies, a marked reduction in the serum IL-6 level from 34 to 8 pg/ml (normal v4) was noticed in this case, whereas anti-BMZ antibodies showed little decrease. Furthermore, slight enhancement of IFN-c was also observed after the treatment, whereas TNF-a was unchanged.

Plasmapheresis Treatment for Bullous Pemphigoid Induces Marked Reduction of the Serum IL-6 Level Rather than the Titre of Circulating Autoantibodies