Funding  None Conflict of interest  None declared What's already known about this topic? Direct immunofluorescence microscopy (DIF) studies represent the gold standard for the diagnosis of bullous pemphigoid (BP). Recent studies have reported that immunohistochemistry techniques using formalin-fixed, paraffinembedded skin biopsy specimens are able to detect tissue-bound immunoreactants in BP with high sensitivity and thus constitute an alternative and practical diagnostic tool. What does this study add? Immunohistochemical analyses are not sensitive enough to recommend their use for the diagnosis of BP, since less than 50% of 51 consecutive paraffin-embedded skin biopsy specimens obtained from patients with newly diagnosed BP were positive. If DIF cannot be performed, immunohistochemistry represents a useful diagnostic tool only in presence of histologically subepidermal blistering and/or with positive immunoserological tests , which are associated with a better sensitivity. Manuscript words 2845, tables 2 and figures 2, Abstract 248Abstract Background: Direct immunofluorescence microscopy (DIF) studies constitute the gold standard for

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