Direct immunofluorescence of plucked hair for evaluation of immunologic remission in pemphigus vulgaris

Miniaturization of sebaceous glands: A novel histopathological finding in pemphigus vulgaris and pemphigus foliaceus of the scalp

“…The sensitivity of DIF of plucked hairs ranges from 85% to 100% . Negative DIF of plucked hairs has been reported to be a marker of pemphigus remission …”

“…[6][7][8] Negative DIF of plucked hairs has been reported to be a marker of pemphigus remission. 9 Acantholysis is a characteristic histopathological feature of pemphigus. It is defined as the loss of intercellular connections between keratinocytes and is typically located over the basal layer of the epidermis in PV and superficially just below the granular layer in pemphigus foliaceus (PF).…”

Loss of normal anagen hair in pemphigus vulgaris

“…Histologically, acantholysis and suprabasal cleft may extend down the follicular epithelium; follicular acantholysis has even been reported as the sole pathological manifestation of pemphigus, and considered a subtle clue for early diagnosis of PV . Direct immunofluorescence also shows immune deposits of IgG and/or C3 in the outer root sheath of hair follicles, and plucked anagen hair has been used as a substrate for diagnosis and also for monitoring immunological remission in PV . These immunopathological findings underlie the normal anagen effluvium (hair loss) seen in pemphigus, which refers to the shedding of normal anagen hairs covered by root sheaths, and is considered analogous to the Nikolsky sign …”

Direct immunofluorescence for immunobullous and other skin diseases

“…Another one has calculated a sensitivity of approximately 91% for DIF of plucked hair in pemphigus patients (n = 110) with positive DIF result of oral mucosa samples [22]. Contrary to this, less is suggested to use DIF of hair as an alternative of conventional DIF for immunological follow-up of PV patients [23]. However, from patients' viewpoint, this solution, DIF of hair, to the problem is simplicity itself relative to DIF of skin specimens [24].…”

“…However, from patients' viewpoint, this solution, DIF of hair, to the problem is simplicity itself relative to DIF of skin specimens [24]. Furthermore, though its sensitivity is poorer than conventional DIF, it is determined statistically good [23,24]. Taken together, now we must modify our sentence mentioned before in the way that DIF of hair has preference to DIF of skin in the case of resistance against skin biopsy, since this resistance can be a source of emotional stress, which is well acknowledged as a potential trigger of AIDs, favorably pemphigus [25].…”