Dermatopathology
Direct immunofluorescence studies of sodium chloride—separated skin in the differential diagnosis of bullous pemphigoid and epidermolysis bullosa acquisita

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Abstract

Bullous pemphigoid and epidermolysis bullosa acquisita may have indistinguishable clinical, histologic, and routine immunohistologic features. In those cases these two diseases can be reliably distinguished in routine diagnostic studies only in seropositive cases by tests on lamina lucida-split skin and in research studies by direct immunoelectron microscopy or, in patients with circulating autoantibodies, by immunoblotting studies. The use of these methods is limited by the expense and unavailability of the methods, the requirement for circulating autoantibodies, or both. We describe a method to distinguish between the two diseases on the basis of findings of direct immunofluorescence of a biopsy specimen after separation through the lamina lucida with 1.0 mol/L sodium chloride. The IgG appeared in the dermal side of the split specimens in epidermolysis bullosa acquisita and predominantly or exclusively in the epidermal side in pemphigoid. The method was found to be relatively simple, inexpensive, applicable to specimens preserved in transport media, and 100% reliable in our group of 22 patients.

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    Supported in part by National Institutes of Health grant Nos. AR30475 and AR10546, the Polish Academy of Science, and Immco Diagnostics, Buffalo, N.Y.

    a

    From the Department of Dermatology, The University of North Carolina, Chapel Hill.

    b

    From the Department of Dermatology, Warsaw Academy of Medicine.

    c

    From the Departments of Microbiology and Dermatology, The Ernest Witebsky Center for Immunology, University at Buffalo, SUNY.

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