Direct immunofluorescence of skin biopsy: Perspective of an immunopathologist

Minz, Ranjana Walker; Chhabra, Seema; Singh, Satnam; Radotra, Bishan Das; Kumar, Bhushan

doi:10.4103/0378-6323.60561

Cited by 40 publications

(23 citation statements)

References 10 publications

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“…DIF helps to detect molecules such as immunoglobulins and complement within the biopsy specimen. [8] The ideal site for the biopsy specimen depends on the type of disorder. For bullous diseases, DIF is performed using the perilesional skin that is normal appearing skin immediately adjacent to a lesion.…”

Section: Discussionmentioning

confidence: 99%

“…This finding was against the previous documentation, which states that DIF is a very reliable diagnostic test for pemphigus, which becomes positive at an early stage and remains positive for a long period after clinical remission. [8] Hence, in the absence of the characteristic DIF pattern, one needs the combination of clinical, histologic, and immunologic data to support the definite diagnosis of different immunobullous disorders.…”

Section: Discussionmentioning

confidence: 99%

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A cross-sectional study of direct immunofluorescence in the diagnosis of immunobullous dermatoses

et al. 2014

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Background:Autoimmune blistering diseases are a group of bullous disorders characterized by pathogenic antibodies directed at the target antigens, which are components of the desmosomes or adhesion complex at the dermoepidermal junction. Direct immunofluorescence (DIF) is invaluable in the diagnosis of these lesions.Aim:The aim of this study was to evaluate the sensitivity of DIF in immunobullous dermatoses and to study the pattern of DIF. The study also aims to correlate DIF with clinical and histologic findings and to analyze discrepancies.Materials and Methods:Total 100 biopsies received over a period of 2 years in the Department of Pathology were analyzed. DIF, histopathology and clinical data were reviewed.Results:Out of 100, 89 cases showed DIF patterns concordant with clinical/histologic diagnosis. The sensitivity of DIF was 94.44% (51/58) in the pemphigus and 84% (21/25) in the bullous pemphigoid (BP) group, 100% each in dermatitis herpetiformis (2/2) and linear IgA disease (1/1). A total of 11 histologically proven cases of immunobullous lesions were DIF negative-four (three of pemphigus vulgaris and one of BP) due to having no epidermis, three (cases of BP) owing to sampling/technical errors and the remaining four (cases of pemphigus vulgaris) due to being on treatment.Conclusion:Immunofluorescence helps confirm the diagnosis of bullous lesions in which there is clinical and the histopathologic overlap. Sampling errors contributed to false negative (FN) results.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A cross-sectional study of direct immunofluorescence in the diagnosis of immunobullous dermatoses

et al. 2014

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“…Also the presence of IgA may not be very specific, but will be helpful in providing a diagnosis of HSP. [25] When there are atypical clinical features. [2526]…”

Section: Discussionmentioning

confidence: 99%

Direct immunofluorescence in cutaneous vasculitis: Experience from a referral hospital in India

Nandeesh

Tirumalae²

2013

Indian J Dermatol

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Background:Cutaneous vasculitis is commonly recognized and biopsied, owing to ease of access. Most biopsies are also subjected to direct immunofluorescence (DIF), though the rates of positivity vary. This is an attempt to assess the utility of DIF and glean data that will help optimize the test.Objective:To assess the diagnostic utility of DIF in cutaneous vasculitis.Materials and Methods:All cases of suspected cutaneous vasculitis submitted for DIF between 2004 and 2010 were included. Clinical data, histopathologic diagnosis, DIF findings and additional tests such as anti nuclear antibody (ANA), anti neutrophil cytoplasmic antibody (ANCA) (where done) were noted.Results:There were 198 patients in the study group, with a female predominance. Purpura was the commonest clinical presentation. Extracutaneous involvement was noted in 29% of patients’ i.e., joint pain, abdominal pain and hematuria. Leukocytoclastic vasculitis was the commonest histologic diagnosis. DIF showed an overall positivity of 39% (n = 77) with C3 in 26% (n = 52) and IgA in 23% (n = 46) cases. Forty one cases of suspected Henoch Schonlein Purpura (HSP) showed IgA positivity. The timing of biopsy ranged from <3 days to six months, with 38% being done within seven days. DIF was positive in 86% of biopsies performed within seven days of onset of lesions. Sixty percent of patients with extracutaneous manifestations showed deposits. Vascular deposits were also noted in dermatitis herpetiformis, dematomyositis and prurigo.Conclusion:DIF positivity is strongly influenced by the timing of the biopsy and the presence of extracutaneous features. Its clinical value is greatest in patients with HSP, being contributory in 90% of cases. Vascular deposits may be seen in non-vasculitic conditions and need clinicopathologic correlation.

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“…); the extent (focal/diffuse); the intensity of fluorescence (+ to ++++); and the pattern of immune complex deposits (granular/linear). [ 5 ]…”

Section: Methodsmentioning

confidence: 99%

Role of direct immunofluorescence in dermatological disorders

Mysorekar

Sumathy

Prasad

2015

Indian Dermatol Online J

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Background:Direct immunofluorescence (DIF) test for tissue-bound autoantibodies, has been found to be of value in the diagnosis of several dermatological disorders. The location and pattern of deposition of immunoreactants helps in classifying various immune-mediated diseases.Aims and Objectives:The aim of this study was to analyze the concordance between the clinical, histopathological and DIF diagnosis in bullous and nonbullous lesions of the skin, and thus determine the impact of immunofluorescence on diagnosis.Materials and Methods:A total of 215 skin biopsies performed in suspected immune-mediated vesiculobullous disease, vasculitis or dermatosis, were studied. Histopathological examination was done along with DIF study for deposits of immunoglobulin G(IgG), IgA, IgM, and C3.Results:Direct immunofluorescence was positive in 103/215 cases. There was very good concordance between the clinical, histological and DIF results (observed agreement = 93.4%, κ =0.90, with 95% confidence interval = 0.86–0.94). The overall sensitivity of DIF in immune-mediated skin disorders was 98.0%. DIF was positive in 52/53 cases (98.1%) in the pemphigus group and 24/25 (96.0%) bullous pemphigoid cases. None of the clinically suspected cases of dermatitis herpetiformis showed DIF positivity. A positive lupus band test was seen in 9/9 (100%) cases of lupus erythematosus. DIF was positive in 10/10 (100%) clinically suspected cases of Henoch–Schönlein purpura. In 110 cases, negative DIF results helped to rule out immune-mediated vesiculobullous disorders, lupus erythematosus and vasculitis, and the final diagnosis was made on the basis of the clinical features and/or histopathology.Conclusion:Direct immunofluorescence is a useful supplement for the accurate diagnosis of immune-mediated dermatological disorders, and helps to classify various autoimmune bullous disorders. When the clinical features/histopathology are inconclusive, the diagnosis often can be made on the basis of the DIF findings alone. A combination of the clinical features, histopathology and DIF usually gives the best results.

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Direct immunofluorescence of skin biopsy: Perspective of an immunopathologist

Cited by 40 publications

References 10 publications

A cross-sectional study of direct immunofluorescence in the diagnosis of immunobullous dermatoses

A cross-sectional study of direct immunofluorescence in the diagnosis of immunobullous dermatoses

Direct immunofluorescence in cutaneous vasculitis: Experience from a referral hospital in India

Role of direct immunofluorescence in dermatological disorders

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