Immunofluorescence in dermatology

Abstract

Direct immunofluorescence (DIF) and indirect immunofluorescence (IIF) tests on skin biopsy are being done mostly in academic teaching hospitals. These tests provide a useful diagnostic aid to dermatologists. Immunohistology and serology can, in conjunction with histology, provide considerable help in delineation and diagnosis of various skin disorders as well as systemic diseases with skin involvement, e.g. systemic lupus erythematosus. Immunofluorescence (IF) studies have now become an invaluable supplement to clinical and histological examination in a variety of dermatological diseases. These skin diseases now include not only bullous and connective tissue disorders, vasculitides, and conditions such as lichen planus, but also the scaling dermatoses, notably psoriasis. In this review article, we share our experience of providing such a diagnostic facility for more than 30 years in a large tertiary care health center in North India and also help to outline the conditions, which can be diagnosed confidently, and others where IF can help in confirming a diagnosis or the immune component of the disease. The article also deals with handling of skin biopsy specimens and interpretation of biopsy findings on DIF and IIF examination.

IgA Pemphigus in a Child – a Case Report

“…The role of DIF techniques on Tzanck smear samples has also been evaluated for the diagnosis of pemphigus vulgaris, and the results were found to be comparable with respective skin biopsies in the same set of patients. Thus, Tzanck smear can be used as a substitute to biopsy (25). In our case, IgA deposits were present on the individual cells and in the intercellular substances where the cells were present in clusters.…”

Childhood Bullous Pemphigoid: A Case Report and Literature Review

“…Direct immunofluorescence (DIF) of skin biopsy of unblistered, perilesional skin (normal-looking skin) reveals linear deposition of IgG and/or complement 3(C3) along the basement membrane zone (BMZ). Indirect immunofluorescence (IIF) shows presence of circulating IgG anti-basement membrane zone antibodies [1][2][3][4]. We report a case of childhood bullous pemphigoid whose skin biopsy showed subepidermal blisters with dermal layer infiltrated with neutrophils.…”

Immunofluorescence in Oral Dermatological Disorders- No Shiny Matter

“…In epidermolysis bullosa acquisita, intense IgG deposition is present [2] . The intensity of C3 deposition is usually less than that of IgG (Figure 4).…”

“…Direct Immunofluorescence of perilesional skin in pemphigus exhibit linear or granular pattern of deposition of immunoglobulins and C3 in the epidermal intercellular spaces [2] . It reveals uniform "fish like net pattern" or "chicken wire pattern" (Figure2).…”

“…This test is carried out by incubating a biopsy specimen with a fluorescein -conjugated anti globulin. As a result of, the unattached antibodies are washed off and the suspected fluorescence labelled conjugate is applied [2,3] . The unbound conjugates are washed off and the slides are viewed under fluoresecent microscope.…”