Direct immunofluorescence diagnosis of pemphigus without biopsy.
BACKGROUND
Direct immunofluorescence (DIF) is a necessary examination tool for the diagnosis of pemphigus. The suction-blister-method splits the skin at the lamina lucida and it is possible with a scalpel to separate the entire epidermis from the dermis.


OBJECTIVE
The study was to determine whether DIF is reliable on epidermal sheets separated using a suction apparatus.


METHODS
Thirteen patients were selected for this study: (nine with pemphigus vulgaris (PV), one with paraneoplastic pemphigus (PP), and three with pemphigus erythematosus (PE). Frozen epidermal sheets, separated from the dermis with a scalpel, were used as a substrate. Diagnosis with routine fluorescein isothiocyanate (FITC) antibodies was made.


RESULTS
In all patients a pericellular deposition of IgG was evident and in eight of these patients a pericellular deposition of C3 was present. In two cases of PE and one of PP, the C3 deposits were also present in the lower part of basal keratinocytes.


CONCLUSIONS
This diagnostic method without skin biopsy is easy to perform and, together with the histology and clinical aspects, could be a useful tool in the diagnosis of pemphigus. We recommend this method when the patient is allergic to local anaesthetics, the patient easily produces hypertrophic scars, or in follow-up of already biopsied patients.
Feliciani
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Department of Dermatology, University "G.D'Annunzio," Chieti, Italy. feliciani@unich.it
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Toto
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Coscione
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D001768:Blister / Q000473:pathology; D003176:Complement C3 / Q000032:analysis; D004817:Epidermis / Q000276:immunology; D019085:Fluorescent Antibody Technique, Direct; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis; D010392:Pemphigus / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology; D013396:Suction
D003176:Complement C3; D007074:Immunoglobulin G