In linear IgA bullous dermatosis (LABD) associated with vancomycin intake, the target antigen and the characteristic immunofluorescence pattern are respectively:

• A Desmoglein-1; IgA in intercellular pattern
• B Type VII collagen; IgA on the floor of salt-split skin
• C LAD-1 (97-kDa ectodomain of BP180); linear IgA at the DEJ ✓
• D Envoplakin; linear IgA at the cell surface

Explanation

Linear IgA bullous dermatosis (LABD) is caused by IgA antibodies against LAD-1, a 97-kDa fragment of the ectodomain of BP180 (also called LABD97). DIF shows linear IgA deposition at the DEJ — the defining immunofluorescence pattern. Vancomycin is the most common drug trigger of LABD. The classic clinical pattern is 'string of pearls' or 'crown of jewels' — new blisters at the periphery of resolving older blisters. Envoplakin is targeted in paraneoplastic pemphigus. Type VII collagen is the target in epidermolysis bullosa acquisita.

Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.

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