2010 Volume 27 Issue 3 Pages 134-142
The incidence of immunological disorders, especially autoimmune bullous diseases, is reported to be increasing in number in Japan after World War II. The reason is still unknown, however, change in dietary habits, namely traditional Japanese diet into western one may be one of reasons; western diet typically contains higher calory, and much richer lipid and protein than Japanese food. We report a case of 54-year-old Japanese woman with western lifestyle habits who had recalcitrant, steroid- and diaminodiphenyl sulfone-resistant linear IgA bullous dermatosis, which was corrected by a change to a traditional Japanese diet combined with intraoral saireito, which has been reported to have steroid-sparing effects. Clinically, her lesions consisted of pruritic annular erythema and bullae on the trunk and extremities. Histopathological specimen showed subepidermal blisters, including many neutrophils. Direct immunohistochemistry specimen showed linear deposition of IgA and C3 at the basement membrane. Indirect immunohistochemistry specimen using patient sera onto normal human skin split by 1 mol/l sodium chloride produced no detectable signal. Immunoelectron microscopy specimen using normal human skin and patient sera showed positive diaminobenzidine deposition on the epidermal side of the lamina lucida. Immunoblot using patient sera onto normal human epidermis showed a 97-kD band. We diagnosed this patient as lamina lucida-type IgA bullous dermatosis targeted to the 97-kD linear IgA antigen. Although a combination of betamethasone and diaminodiphenyl sulfone, well-established conventional therapy, did not control the skin symptoms, the patient was well controlled after the addition of this combination of Japanese diet and the Kampo herb therapy, saireito.