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We appreciate Bystryn's comments and agree that a more appropriate site selection for immunofluorescence biopsy in patients in whom systemic lupus erythematosus is being considered is a less exposed area. Our study, however, was meant to address the rate of "false" positivity on an exposed surface such as the head or neck. We chose the lateral aspect of the neck to minimize the visibility of the scar from our punch biopsy. It is possible that the rate of false positivity would be even higher from facial skin. The most important issue that we addressed was the use of the immunofluorescence study to diagnose cutaneous lupus erythematosus.
Callen JP, Fabré VC, Hodge SJ. Limitations of Direct Immunofluorescence-Reply. Arch Dermatol. 1992;128(2):272. doi:10.1001/archderm.1992.01680120148025