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Accuracy of indirect immunofluorescence on sodium chloride-split skin in the differential diagnosis of bullous pemphigoid and epidermolysis bullosa acquisita.
Indian J Dermatol Venereol Leprol. 2011 Nov-Dec; 77(6):677-82.IJ

Abstract

BACKGROUND

Previous reports have shown that indirect immunofluorescence (IIF) performed on sodium chloride-split skin (SSS) is helpful to differentiate epidermolysis bullosa acquisita (EBA) from bullous pemphigoid (BP). Antibodies of BP may bind to the epidermal side of SSS, while antibodies of EBA bind to the dermal side.

AIMS

To determine the accuracy of IIF-SSS in the differential diagnosis of EBA and BP utilizing immunoblotting (IB) analysis.

METHODS

Sera from 78 patients, diagnosed with BP by clinical features, histopathology, and direct immunofluorescence (DIF), were assayed using IIF-SSS and IB.

RESULTS

Of the 43 serum samples with an epidermal reaction to IIF-SSS assay, 42 were recognized with BP antigens (180 kDa or 230 kDa). Of the 11 serum samples with a dermal reaction pattern, 7 were recognized with the 290 kDa antigen of EBA and 3 with sera bound BP antigens. Seven serum samples with epidermal and dermal combined staining, of which 5 of them reacted with BP antigens, 1 reacted with both BP and EBA antigens. One serum sample from each group showed a negative result by IB. Approximately 9.0% (7/78) of patients diagnosed with BP using regular methods were actually EBA.

CONCLUSIONS

Epidermal reaction using the IIF-SSS assay highly correlated with the diagnosis of BP. However, dermal reactions correlated poorly with EBA, with some serum samples from BP patients binding to dermal-side antigens. In both epidermal and dermal stained sera using IIF-SSS, there was a possibility of BP and EBA. Differential diagnosis should be confirmed using IB, especially in cases of dermal and double staining patterns assayed using IIF-SSS.

Authors+Show Affiliations

Shandong Provincial Institute of Dermatology and Venereology, Shandong Provincial Academy of Medical Science, Jinan, China.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22016274

Citation

Yang, Baoqi, et al. "Accuracy of Indirect Immunofluorescence On Sodium Chloride-split Skin in the Differential Diagnosis of Bullous Pemphigoid and Epidermolysis Bullosa Acquisita." Indian Journal of Dermatology, Venereology and Leprology, vol. 77, no. 6, 2011, pp. 677-82.
Yang B, Wang C, Chen S, et al. Accuracy of indirect immunofluorescence on sodium chloride-split skin in the differential diagnosis of bullous pemphigoid and epidermolysis bullosa acquisita. Indian J Dermatol Venereol Leprol. 2011;77(6):677-82.
Yang, B., Wang, C., Chen, S., Chen, X., Zhou, G., Tian, H., Yu, M., Zhang, D., Shi, Z., & Zhang, F. (2011). Accuracy of indirect immunofluorescence on sodium chloride-split skin in the differential diagnosis of bullous pemphigoid and epidermolysis bullosa acquisita. Indian Journal of Dermatology, Venereology and Leprology, 77(6), 677-82. https://doi.org/10.4103/0378-6323.86479
Yang B, et al. Accuracy of Indirect Immunofluorescence On Sodium Chloride-split Skin in the Differential Diagnosis of Bullous Pemphigoid and Epidermolysis Bullosa Acquisita. Indian J Dermatol Venereol Leprol. 2011 Nov-Dec;77(6):677-82. PubMed PMID: 22016274.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Accuracy of indirect immunofluorescence on sodium chloride-split skin in the differential diagnosis of bullous pemphigoid and epidermolysis bullosa acquisita. AU - Yang,Baoqi, AU - Wang,Chong, AU - Chen,Shengli, AU - Chen,Xuechao, AU - Zhou,Guizhi, AU - Tian,Hongqing, AU - Yu,Meiling, AU - Zhang,Dizhan, AU - Shi,Zhongxiang, AU - Zhang,Furen, PY - 2011/10/22/entrez PY - 2011/10/22/pubmed PY - 2012/3/1/medline SP - 677 EP - 82 JF - Indian journal of dermatology, venereology and leprology JO - Indian J Dermatol Venereol Leprol VL - 77 IS - 6 N2 - BACKGROUND: Previous reports have shown that indirect immunofluorescence (IIF) performed on sodium chloride-split skin (SSS) is helpful to differentiate epidermolysis bullosa acquisita (EBA) from bullous pemphigoid (BP). Antibodies of BP may bind to the epidermal side of SSS, while antibodies of EBA bind to the dermal side. AIMS: To determine the accuracy of IIF-SSS in the differential diagnosis of EBA and BP utilizing immunoblotting (IB) analysis. METHODS: Sera from 78 patients, diagnosed with BP by clinical features, histopathology, and direct immunofluorescence (DIF), were assayed using IIF-SSS and IB. RESULTS: Of the 43 serum samples with an epidermal reaction to IIF-SSS assay, 42 were recognized with BP antigens (180 kDa or 230 kDa). Of the 11 serum samples with a dermal reaction pattern, 7 were recognized with the 290 kDa antigen of EBA and 3 with sera bound BP antigens. Seven serum samples with epidermal and dermal combined staining, of which 5 of them reacted with BP antigens, 1 reacted with both BP and EBA antigens. One serum sample from each group showed a negative result by IB. Approximately 9.0% (7/78) of patients diagnosed with BP using regular methods were actually EBA. CONCLUSIONS: Epidermal reaction using the IIF-SSS assay highly correlated with the diagnosis of BP. However, dermal reactions correlated poorly with EBA, with some serum samples from BP patients binding to dermal-side antigens. In both epidermal and dermal stained sera using IIF-SSS, there was a possibility of BP and EBA. Differential diagnosis should be confirmed using IB, especially in cases of dermal and double staining patterns assayed using IIF-SSS. SN - 0973-3922 UR - https://www.unboundmedicine.com/medline/citation/22016274/Accuracy_of_indirect_immunofluorescence_on_sodium_chloride_split_skin_in_the_differential_diagnosis_of_bullous_pemphigoid_and_epidermolysis_bullosa_acquisita_ L2 - http://www.ijdvl.com/article.asp?issn=0378-6323;year=2011;volume=77;issue=6;spage=677;epage=682;aulast=Yang DB - PRIME DP - Unbound Medicine ER -