Diagnostic value of indirect immunofluorescence on sodium chloride-split skin in differential diagnosis of subepidermal autoimmune bullous dermatoses.
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).


METHODS
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.


METHODS
An immunodermatology laboratory.


METHODS
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).


METHODS
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 alpha 3 or beta 3 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.


CONCLUSIONS
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.
Ghohestani
R F
RF
Department of Dermatology, Edouard Herriot Hospital, Lyon, France.
Nicolas
J F
JF
Rousselle
P
P
Claudy
A L
AL
D000918:Antibody Specificity; D001323:Autoantibodies / Q000032:analysis; D001324:Autoantigens / Q000276:immunology; D001327:Autoimmune Diseases / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004591:Electrophoresis, Polyacrylamide Gel; D000939:Epitopes; D019084:Fluorescent Antibody Technique, Indirect; D006801:Humans; D015151:Immunoblotting; D012867:Skin / Q000187:drug effects* / Q000276:immunology; D012872:Skin Diseases, Vesiculobullous / Q000175:diagnosis*; D012965:Sodium Chloride
D001323:Autoantibodies; D001324:Autoantigens; D000939:Epitopes; D012965:Sodium Chloride