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Ann Marie Powell, MB, MRCPI; Yohko Sakuma-Oyama, MD; Noritaka Oyama, MD, PhD; Sandra Albert, MD, DNB; Balbir Bhogal, BSc; Fumio Kaneko, MD, PhD; Takeji Nishikawa, MD, PhD; Martin M. Black, MD, FRCP, FRCPath

Arch Dermatol. 2005;141:705-710.

Background  Pemphigoid gestationis (PG) is a rare pregnancy-associated subepidermal immunobullous disease that targets hemidesmosomal proteins, particularly BP180. Clinically, PG can resemble the eruption known as polymorphic urticarial papules and plaques of pregnancy (PUPPP), and accurate differentiation between these 2 pruritic pregnancy dermatoses has important implications for fetal and maternal prognoses. Results of epitope mapping studies show that IgG autoantibodies in up to 90% of PG serum samples target the well-defined membrane-proximal NC16a domain of BP180.

Objective  To examine the usefulness of a commercially available NC16a domain enzyme-linked immunosorbent assay in the serodiagnosis of PG and in the differentiation of PG from PUPPP.

Participants  A total of 412 women consisting of pretreatment patients with PG (n = 82), patients with PUPPP (n = 164), and age- and sex-matched controls (n = 166).

Methods  All serum samples were assayed in duplicate. Receiver operating characteristic analyses were performed to determine a cutoff value for the diagnosis of PG and for differentiation from PUPPP and controls.

Results  A cutoff value of 10 enzyme-linked immunosorbent assay units was associated with specificity and sensitivity of 96%.

Conclusions  The NC16a enzyme-linked immunosorbent assay is highly sensitive and highly specific in differentiating PG from PUPPP, and it is potentially a valuable tool in the serodiagnosis of PG.

Author Affiliations: Department of Dermatological Immunopathology, St John’s Institute of Dermatology, St Thomas’ Hospital, London, England (Mss Powell and Bhogal and Drs Sakuma-Oyama, Oyama, Albert, and Black); Department of Dermatology, Fukushima University School of Medicine, Fukushima, Japan (Dr Kaneko); and Department of Dermatology, Keio University School of Medicine, Tokyo, Japan (Dr Nishikawa).

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