Direct Immunofluorescence Staining Patterns in Vesiculobullous Dermatoses

Description

The vesiculobullous dermatoses may be difficult to differentiate based solely on clinical grounds. The staining pattern seen on direct immunofluorescent testing with various antisera may be characteristic for certain conditions. This can be very helpful in reaching a final diagnosis.

Methodology:

(1) A biopsy is taken from an evolving area of involved skin.

(2) The tissue is either (a) kept moist with sterile saline without fixation, or (b) placed in a suitable fixative for immunofluorescence (not formalin).

(3) Frozen sections are prepared.

(4) Appropriate antisera are applied using staining protocols.

(5) The slides are then examined using a fluorescent microscope.

Parameters:

(1) antigen present: IgA, IgG, IgM, complement (using anti-IgA, anti-IgG, anti-IgM, anti-C3)

(2) structures stained: basement membrane zone, intercellular substance between squamous epithelial cells, blood vessels

(3) pattern: linear, granular, lacelike

Site	Antigen	Pattern	Disorder
basement membrane zone	IgM, C3	granular	erythema multiforme
basement membrane zone	IgG, C3	granular	paraneoplastic pemphigus
basement membrane zone	IgG, C3	granular	bullous SLE
basement membrane zone	IgA	granular	dermatitis herpetiformis
basement membrane zone	IgG, C3	linear	paraneoplastic pemphigus
basement membrane zone	IgG, C3	linear	bullous pemphigoid
basement membrane zone	IgG, C3	linear	cicatricial pemphigoid
basement membrane zone	C3	linear	herpes gestationalis
basement membrane zone	IgG, C3	linear	epidermolysis bullosa acquisita
basement membrane zone	IgG, C3	linear	bullous SLE
basement membrane zone	IgA	linear	linear IgA dermatosis
intercellular	IgG	lacelike	pemphigus, several variants
intercellular	IgG	lacelike	paraneoplastic pemphigus
intercellular	IgA	lacelike	IgA pemphigus
vessels	IgM, C3	granular	erythema multiforme

after Table 9-4, page 229

Limitations:

• Improper handling of the specimen can result in false positive and false negative reactions.

• Taking a sample from an advanced lesion may result in inconclusive findings due to degenerative change in the tissue.

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Direct Immunofluorescence Staining Patterns in Vesiculobullous Dermatoses

Description

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