title: Clinicopathological significance of cutaneous epidermal nuclear staining by direct immunofluorescence.
abstract: Epidermal antinuclear antibody (ANA) staining was noted during routine direct immunofluorescence (DIF) of skin biopsies from 22 cases at St John's Dermatology Centre over a 2-year period. We have reviewed the clinical, serological and immunopathological features of these patients. They comprised 13 cases of lupus erythematosus (LE), 3 dermatomyositis, 1 morphoea, 1 systemic sclerosis, 1 CREST syndrome, 1 mixed connective tissue disorder and 1 probable cutaneous sarcoidosis. Five (38.4%) patients with LE had moderate to severe oral mucosal involvement. Epidermal nuclear staining (ENS) was seen following IgG deposition in 21 cases and IgA in only 1 case. Complement C3 staining was an additional feature in 1 patient. Circulating ANA was absent in 7 cases at the time of biopsy, confirming that this pattern of staining does not occur as a result of tissue contamination during processing. The presence of ENS by DIF corroborates a diagnosis of a connective tissue disorder, and our results suggest that it may also be associated with oral involvement in L.E.
authors.affiliation: Department of Immunofluorescence, UMDS, St Thomas' Hospital, London, UK.
authors.forename: N P
authors.initials: NP
authors.lastname: Burrows
authors.forename: B S
authors.initials: BS
authors.lastname: Bhogal
authors.forename: R
authors.initials: R
authors.lastname: Russell Jones
authors.forename: M M
authors.initials: MM
authors.lastname: Black
mesh_terms: D000293:Adolescent; D000328:Adult; D000974:Antibodies, Antinuclear / Q000032:analysis*; D003240:Connective Tissue Diseases / Q000276:immunology* / Q000473:pathology; D004817:Epidermis / Q000276:immunology* / Q000473:pathology; D005260:Female; D005455:Fluorescent Antibody Technique; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D000974:Antibodies, Antinuclear