title: Diagnostic Value of Linear Fluorescence Along the Basement Membrane of Sweat Gland Ducts in Bullous Pemphigoid.
abstract: Linear IgG deposits along the basement membrane of adnexa has been proposed to be useful in the diagnosis of bullous pemphigoid (BP), but no controlled studies have been performed. This study evaluated linear IgG fluorescence of the basement membrane of sweat gland ducts (SGD) and other adnexa in perilesional biopsies from patients with BP (n = 64) and controls (n = 82), using direct immunofluorescence microscopy. Fluorescence intensity was graded semi-quantitatively. Positive SGDs were found in 58 (90.6%) patients with BP and 44 (53.7%) controls, a statistically significant difference (p < 0.0001). The sensitivity of positive SGDs for BP was high (90.6%), but the specificity was low (46.3%). Only strong fluorescence intensity was associated with high specificity. In conclusion, positive SGDs in direct immunofluorescence microscopy are highly sensitive for BP; however, only strong fluorescence has acceptable specificity. Weak positivity of SGDs without linear fluorescence of the epidermal basement membrane may not be sufficiently specific for BP.
authors.affiliation: Department of Dermatology and Allergology, Ludwig-Maximilian University, Frauenlobstr. 9-11, DE-80337 Munich, Germany. isinsinem@hotmail.com.
authors.forename: Işın Sinem
authors.initials: IS
authors.lastname: Bağcı
authors.forename: Orsolya N
authors.initials: ON
authors.lastname: Horváth
authors.forename: Enno
authors.initials: E
authors.lastname: Schmidt
authors.forename: Thomas
authors.initials: T
authors.lastname: Ruzicka
authors.forename: Miklós
authors.initials: M
authors.lastname: Sárdy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001323:Autoantibodies / Q000032:analysis*; D001324:Autoantigens / Q000276:immunology*; D001485:Basement Membrane / Q000276:immunology* / Q000473:pathology; D015415:Biomarkers / Q000032:analysis; D016022:Case-Control Studies; D002648:Child; D000071821:Dystonin / Q000276:immunology*; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis*; D008163:Luminescent Measurements; D008297:Male; D008856:Microscopy, Fluorescence; D008875:Middle Aged; D024041:Non-Fibrillar Collagens / Q000276:immunology*; D010391:Pemphigoid, Bullous / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D013545:Sweat Glands / Q000276:immunology* / Q000473:pathology; D014421:Turkey; D055815:Young Adult; D000097805:Collagen Type XVII
chemical_list: D001323:Autoantibodies; D001324:Autoantigens; D015415:Biomarkers; D000071821:Dystonin; D007074:Immunoglobulin G; D024041:Non-Fibrillar Collagens; D000097805:Collagen Type XVII; C486268:DST protein, human