A 60-year-old male presented to the dermatology OPD with large tense bullae on large uicarial plaques with some of the bullae being hemorrhagic. On examination, the bullae did not rupture easily with absence of Nikolsky's and bulla spread sign. Some of the lesions healed with milia formation. Direct immunofluorescence test of the skin biopsy was done. Which of the following structures is most likely to be involved: -
High-Yield Explanation
This is a case of Bullous pemphigoid. Absence of Nikolsky's sign and bulla spread sign rule out pemphigus. Most common protein involved is BP230 > BP180. DIF shows a linear band of immunoglobulin G deposit along the Dermoepidermal junction.