Dermatitis Herpetiformis and Herpes Gestationis: Analysis of γA and γM Serum Proteins by Immunoelectrophoresis*

Since 1948 when Robert (1) reported serum protein patterns in several dermatoses examined with the macroelectrophoretic method of Ti-selius, there have been numerous reports dealing with serum protein changes in dermatologie disorders (2-5). After the development of paper electrophoresis serum proteins were further characterized in these diseases. It was anticipated that these methods would be of some diagnostic value in differentiating closely allied diseases when clinical and histologic data were insufficient. These expectations have not been fully realized since specific patterns have not been found for various diseases and the electrophoretic patterns have not been diagnostic (6). However, non-specific but characteristic changes of the serum protein fractions have been found in certain diseases or disease states such as acute pemphigus vulgaris (6-10). In dermatitis herpetiformis (D.H.) most authors have found minimal changes in the electrophoretic patterns of the serum proteins. Robert (1) reported electrophoretic analysis of 2 cases of D.H. which showed a slight decrease in the serum albumin and a slight increase in the alpha and beta globulin fractions, with normal total proteins. Lever et al (2) examined 5 patients with the same disease and found no significant abnormalities in any of the serum electrophoretic patterns. His reported values for total proteins were normal with the exception of mild hypoproteinemia in one case. Rochl and Jaroschka (9) described 6 cases of D.H. which showed very minor changes in the protein fractions : the alpha globulin fractions were slightly increased, especially in those cases with widespread eruptions and secondary infection; again the total proteins were normal. Haensch (4) investigated 5 patients with D.H. and found a slight increase in beta globulin but it was not consistent in all cases. He also found that the gamma globulins were slightly increased. The total serum proteins were normal. He felt that the marked protein changes in pemphigus vulgaris might be used as a diagnostic aid in the differential diagnosis of this disorder from D.H. However in mild cases of pemphigus vulgaris the protein fraction alterations were slight as Lever et al (6) had previously reported. Bonelli and Da-voto (7) studied 7 cases of pemphigus vulgaris, 8 cases of D.H., and 3 cases of herpes gesta-tionis (H.G.). They found in D.H. an increase in the alpha and gamma globulin fractions, a decrease in the concentration of albumin and normal total proteins, but they often found similar values in all 3 diseases. Pozzo and Hoffman (11) reported approximately the same findings in a series of 13 patients with D.H, 3 with H.G. and 10 patients with pemphigus vulgaris. Madras and Stoberl (10) examined 4 cases of D.H. and found a slight decrease in albumin, a slight increase in alpha-1 globulin and a pronounced increase in alpha-2 globulin. There were no significant changes in the beta and gamma globulins. They also felt as Haensch (4) and Leinbrock (8, 12) that electrophoresis could be of help in the differential diagnosis between pemphigus and dermatitis herpetiformis. Alexander (13) analyzed serum from 16 patients with the adult type of D.H. and from 17 patients who were under control by dapsone therapy. His results showed “that in adult dermatitis herpetiformis there is a significantly lower than normal level of al protein after treatment with dapsone and a level of al glycoproteins significantly below normal in active cases of this disorder, which are further lowered by treatment.