The standard pemphigoid ELISA missed a third of cases in a laboratory series

The edition in brief

In 100 consecutive sera with an epidermal pattern on split-skin indirect immunofluorescence, the commercial BP180 NC16A ELISA was positive in 66% and BP230 in 52%, while an ELISA against LABD97, a larger fragment of BP180, was positive in 87% and caught 83% of those negative on both commercial tests. The practical point is that a negative standard ELISA does not exclude pemphigoid. In 50 Chinese women with epidermal melasma, adding intradermal hyaluronic acid with glutathione to low-fluence Nd:YAG laser and oral tranexamic acid lowered mMASI by about 0.7 points more, but only 36 completed. In a UK feasibility study, 20 adults with palmoplantar pustulosis on upadacitinib had PP-PASI fall from 20.3 to 4.6 in eight weeks, compared with historic placebo data; a randomised trial is now planned. In 277 patients with advanced mycosis fungoides or Sézary syndrome, the Cutaneous Lymphoma International Prognostic Index separated median progression-free survival of 4.6, 2.7 and 0.9 years. The pearl: melasma needs protection from visible light, not just UV.