title: Diagnosing Pemphigus foliaceus: a retrospective analysis of clinical, histological and immunological criteria.
abstract: BACKGROUND
  Clinical, histological and immunological criteria distinguish pemphigus foliaceus (PF) from pemphigus vulgaris (PV), but whether and how often they are concordant in the same patient is unknown.
  
  
  METHODS
  Seven clinical records were selected from two hospital settings for having a diagnosis of PF and the initial serum and histopathological specimens still available. Controls were 8 PV records selected in the same way. Histopathological slides were re-evaluated. Stored sera were studied by indirect immunofluorescence (IIF), Western blot and ELISA.
  
  
  RESULTS
  Acantholysis was superficial in all PF patients and deep in all PV patients. Mucosal lesions were not exclusive of PV. IIF was positive in 43% of PF patients. Western blot revealed desmoglein 1 in 86% of PF patients and in 25% of PV. ELISA revealed anti-desmoglein-1 antibodies in up to 71% of PF and in 62% of PV patients, in 1 failing to detect anti-desmoglein-3 antibodies.
  
  
  CONCLUSIONS
  Histopathology remains the most reliable criterion for diagnosing PF. Western blot and ELISA, especially in combination, may be only of confirmatory value.
authors.affiliation: Section of Dermatology, DiSEM, Genoa, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Delmonte
authors.forename: J
authors.initials: J
authors.lastname: Kanitakis
authors.forename: E
authors.initials: E
authors.lastname: Cozzani
authors.forename: A
authors.initials: A
authors.lastname: Parodi
authors.forename: A
authors.initials: A
authors.lastname: Rebora
mesh_terms: D000051:Acantholysis; D000328:Adult; D000368:Aged; D015153:Blotting, Western; D015820:Cadherins / Q000032:analysis*; D051183:Desmoglein 1; D051184:Desmoglein 3; D003937:Diagnosis, Differential; D004804:Eosinophils; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D006801:Humans; D008297:Male; D008875:Middle Aged; D010392:Pemphigus / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology; D012189:Retrospective Studies
chemical_list: D015820:Cadherins; C071894:DSG3 protein, human; D051183:Desmoglein 1; D051184:Desmoglein 3