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September 1997

Diagnostic Value of Indirect Immunofluorescence on Sodium Chloride-Split Skin in Differential Diagnosis of Subepidermal Autoimmune Bullous Dermatoses

Author Affiliations

From the Department of Dermatology and INSERM U80, Edouard Herriot Hospital (Drs Ghohestani, Nicolas, and Claudy), and the Institute of Protein Biology and Chemistry, CNRS (Dr Rousselle), Claude Bernard University, Lyon, France.

Arch Dermatol. 1997;133(9):1102-1107. doi:10.1001/archderm.1997.03890450048006

Objective:  To determine the diagnostic value of indirect immunofluorescence on sodium chloride—split skin (SSS) in differentiating the pemphigoid group of subepidermal autoimmune bullous dermatoses, including bullous pemphigoid (BP), cicatricial pemphigoid, and pemphigoid gestationis, from epidermolysis bullosa acquisita (EBA).

Design:  Serum samples were tested using immunofluorescence on SSS and immunoblot assay on epidermal and dermal extracts, a recombinant protein corresponding to the C-terminal end of the 230-kd BP antigen, and purified laminin-5.

Setting:  An immunodermatology laboratory.

Patients:  One hundred forty-two serum samples from patients with BP (n=98), cicatricial pemphigoid (n=23), pemphigoid gestationis (n=10), EBA (n=10), and anti— type IV collagen (n=1).

Main Outcome Measures:  Binding sites of serum to the epidermal and/or dermal sides of SSS were correlated with their antigenic specificities.

Results:  Epidermal staining on SSS was highly specific for pemphigoid. Alternatively, a poor correlation was found for the dermal-reacting serum samples and the diagnosis of EBA; of the 19 serum samples with dermal staining on SSS, only 10 reacted with the EBA antigen. The remaining serum samples were from patients with cicatricial pemphigoid having antibodies to the α3 or β3 chains of laminin-5 (n=5) or patients with BP having antibodies to the 180-kd BP antigen (n=2). One sample recognized exclusively a 185-kd dermal antigen corresponding to type IV collagen. One more BP serum sample with dermal staining did not recognize any dermal or epidermal antigen.

Conclusion:  In case of immunofluorescent dermal staining, the precise diagnosis should be confirmed by identification of the involved antigen, since it may reveal antibodies to laminin-5 or type XVII or IV collagen, in addition to the EBA antigen.Arch Dermatol. 1997;133:1102-1107