Bullous Dermatosis vs Amyloidosis-Reply

In Reply.— Myeloma is often associated with amyloidosis. In our patient, there were no clinical findings suggestive of amyloidosis. Results of a histologic examination of the skin did not show dermal amyloidosis, and specific stains for amyloid were negative. Therefore, the initial mechanism in the formation of the bulla does not seem to be a cleavage through fragile dermal amyloid deposits. Concerning this patient, we would like to add that he was severely burned 12 years ago. Severely burned patients can elaborate antibodies against the cytoplasm of basal cells of the epidermis. 1 According to the two-hit theory of myeloma formation, this tumor could be linked to the neoplastic proliferation of the plasma cell line producing that antibody. 2 This hypothesis is only speculative and does not contribute any information concerning the pathogenic role of this antibody for the dermatosis.