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S6C26P20-3: Progressions in the life history of a lesion of cicatricial pemphigoid
is depicted with the vector, representing time, directed to the right. In an early lesion (i.e., to the left), the bulla is subepidermal; fibrin has condensed along the denuded surface. In response to the release of digestive enzyme by disintegrating neutrophils, the basement membrane and neighboring reticular (and elastic) fibers are digested. Fibrocytes proliferate in the damaged sites; they extend through the region of digested basement membrane into the condensed fibrin; capillaries follow. In this manner, the process of organization of a fibrinous exudate is initiated. The fibrosing reaction continues as the insult along the demal-epidermal interface smolders. Eventually, the fibrin will be converted to fibrous tissue (accretive fibrosis) and the vertical dimensions of a band of altered fibrous tissue will be expanded. With time, the fibrosing reaction will even extend into the upper portion of the reticular dermis (far right - streaked, parallel collagen bundles).
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