Histomorphologic and Direct Immunofluorescence Findings of Autoimmune Bullous Disease

Abstract

Autoimmune bullous diseases mainly present with vesiculobullous reaction pattern.First algorithm to approach skin biopsy of autoimmune vesiculobullous disease should be localization of the anatomic level of the split, which could be either intraepidermal or subepidermal. Second, inflammatory cell component should be evaluated, which could vary due to age of the lesion. Third, presence or absence of acantholysis should be considered. Finally, pattern of positive immunofluorescence results or negativity helps to render definitive diagnosis. In this chapter, practical histopathology and direct immunofluorescence findings of autoimmune bullous disease are discussed and supported by illustrative microphotographs taken from cases within our institution.

Lymphocyte‐predominant lesional inflammatory infiltrates of the skin are associated with mucosal‐dominant phenotype in pemphigus

“…Conversely, PF displays a more superficial, subcorneal split, early adnexal involvement and late lesions exhibit acanthosis and parakeratosis 4 . Both are accompanied by a perivascular dermatitis with mixed inflammatory infiltrates 6 . Notwithstanding the fundamental role of immunoassays in the diagnosis of pemphigus, histopathology could further aid in the correct assessment of different clinical and immunological subtypes.…”