title: Real-time, non-invasive microscopic confirmation of clinical diagnosis of bullous pemphigoid using in vivo reflectance confocal microscopy.
abstract: BACKGROUND
  Bullous pemphigoid is an autoimmune disease affecting prevalently the elder. In vivo reflectance confocal microscopy is a non-invasive technique for real-time imaging of the skin with cellular-level resolution. No previous data has been reported about confocal microscopy of bullous pemphigoid. Aim of this preliminary study is the evaluation of the potential of in vivo reflectance confocal microscopy for real-time, microscopical confirmation of clinical bullous pemphigoid diagnosis.
  
  
  METHODS
  A total of nine lesions from patients affected by pemphigoid underwent in vivo reflectance confocal microscopy before histological examination.
  
  
  RESULTS
  In our preliminary study, confocal microscopy showed high grade of correspondence to histopathology. In particular, presence of sub-epidermal cleft and variable amount of oedema of the upper dermis associated with inflammatory cells infiltration were seen as prevalent confocal features in the bullous lesions considered. Differently, in urticarial lesions, no specific features could be appreciated at confocal analysis beside the presence of signs of spongiosis and perivascular inflammation.
  
  
  CONCLUSIONS
  Confocal microscopy seems to be useful for in vivo, microscopical confirmation of the clinical suspect of bullous pemphigoid and for biopsy site selection in urticarial lesions to obtain a more significant specimen for histopathological examination.
authors: San Gallicano Dermatological Institute, Rome, Italy.
authors: M
authors: M
authors: Ardigò
authors: M
authors: M
authors: Agozzino
authors: B
authors: B
authors: Amorosi
authors: E
authors: E
authors: Moscarella
authors: C
authors: C
authors: Cota
authors: L
authors: L
authors: de Abreu
authors: E
authors: E
authors: Berardesca
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003199:Computer Systems; D046169:Dermoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008297:Male; D018613:Microscopy, Confocal / Q000379:methods*; D008875:Middle Aged; D015588:Observer Variation; D010391:Pemphigoid, Bullous / Q000473:pathology*; D010783:Photometry / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012867:Skin / Q000473:pathology*
keywords: autoimmune bullous diseases; bullous pemphigoid; in vivo reflectance confocal microscopy; non-invasive diagnosis; real-time microscopy; sub-epidermal cleft