Epidermolysis bullosa acquisita controlled by cyclosporine

An 83-year-old woman presented with blisters on both feet, the lower legs, and the buttocks. Histopathological examination demonstrated subepidermal bullae and mild lymphocytic perivascular infiltration in the upper dermis. Direct immunofluorescence examination showed the linear deposition of IgG at the epidermal basement membrane zone. Indirect immunofluorescence examination of normal human skin split using 1M NaCl showed IgG reactivity on the dermal side. Enzyme-linked immunosorbent assays detected IgG autoantibody against type? collagen recombinant protein. The patient was diagnosed as epidermolysis bullosa acquisita based on the clinical and pathological findings. Although the patient was treated with oral prednisolone 25 mg (0.5 mg/kg)/day, the symptoms did not improve. We added cyclosporine 50 mg (1 mg/kg)/day and increased the dose to 75 mg (1. 6 mg/kg)/day after one week. One week later, the patient improved dramatically with the cessation of new blister formation. We report a case with epidermolysis bullosa acquisita that was successfully treated with low-dose cyclosporine. This report indicates the efficacy of cyclosporine in treating epidermolysis bullosa acquisita.