Direct immunofluorescence of skin biopsy: Perspective of an immunopathologist.

Background: By direct immunofluorescence (DIF), presence of immune complexes in the skin biopsy at various locations such as the dermo-epidermal junction, dermal blood vessels, etc. help to arrive at a diagnosis. Aims: (1) To study the role of DIF in confirmation or exclusion of diseases involving skin vis-à-vis histopathology and clinical diagnosis, (2) to describe the annual spectrum of dermatologic conditions that present to a tertiary referral center and require DIF examination of skin biopsy for confirmation of diagnosis. Methods: A total of 267 biopsies received over a period of 16 months in the Department of Immunopathology were analyzed along with clinical and histopathological details and the correlation between them was studied. Results: DIF was positive in 204 skin biopsies. Of these, 127 biopsies showed good clinico-immuno-histopathological correlation. In 10 cases, only DIF could clinch the diagnosis. In another nine cases, immune deposits were noted, which were unexpected in light of clinical and histopathological diagnosis. The most common skin involvement was seen in vasculitides. DIF was, however, non-contributory in lesions like erythema multiformè, post Kala-azar dermal leishmaniasis, sarcoidosis, lupus vulgaris, pyoderma gangrenosum and prurigo nodularis. Conclusion: The DIF of skin in conjunction with histopathology gives the best diagnostic yield. It is invaluable in confirming the diagnosis of small vessel vasculitides and bullous lesions of skin and can be used as an additional tool to pinpoint the diagnosis of systemic and localized autoimmune diseases involving the skin.

Diagnostic significance of lupus band test in systemic lupus erythematosus / 中华风湿病学杂志

0 05).Of patients with lupus renal lesions 86% had a positive LBT (+LBT),which was significantly higher than that of patients without renal lesions(37%) ( P

The Pattern of Epidermal Immune Deposits in Patients with High - Titer Anti - Ro Positive Lupus Erythematosus / 대한피부과학회지

BACKGROUND: Antibodies to Bo antigen are present in most patients with subacute cutaneous lupus erythematosus and in about 50% of Korean patients with systemic lupus erythematosus (LE). However, the pattern of in vivo epidermal deposits of anti Ro antibodies has not been widely recognized. OBJECTIVE: The purpose of thjs study was to define characteristic findings of direct and indirect immunofluorescence(IF) in patients with high-titer anti-Ro or anti-Ro/La positive LE. METHODS: Lupus band test (riirect IF with normal appearing forearm skin specimens) and indi- rect IF with normal skin substr ates were performed with 3 patients of systemic LE who have high titers( >1: 640) of anti-Ro or anti-Ro/La antibodies but have no antibodies against other nuclear antigens such as nDNA/Sm/nRNP/Scl-70. RESULTS: An identical pattern of immune deposits was observed in the epidermis in all 3 pa- tients through direct and indirect, IF examinations. The characteristic pattern recognized was "fine speckling" of IgG (or IgG/IgM) mainly at the nuclei on the basal keratinocytes or keratinocytes throught the epidermis. In the immunoblot assay performed with one patient, IgG anti-Ro/La anti- bodies were identified to recognize the 52/42kD antigens (probably, the Ro/La antigens) in the cultured keratinocyte extracts. CONCLUSION: Most direct IF studies in patients with systemic LE(lupus band test) have shown granular depositions of immunoglabulins and complement components along the dermoepidermal junction, however, the staining patterns as observed in this study may have been overlooked. The recognizable fine speckled patteen of immune deposits at the epidermal keratinocytes could he taken into account as a positivi. finding in the broad category of "lupus band", seen with the normal appearing skin in patient s with systemic LE, especially, who have high titers of anti-Ro/ La antibodies.

Relationship of Clinical and Laboratory Findings to Lupus Band Test in Patients with Systemic Lupus Erythematosus / 대한피부과학회지

The lupus band test(LHT) has been proposed as a diagnostic test for lupus erythematosus(LE), differentiating discoid I E from systemic LE and also has prognostic values. For the better understanding of relation between LBT and prognosis in SLE. a study was carried out in 32 SLE patients with skin lesions. Immunofluorescent study was done with biopsies taken from involved skin and uninvolved skin of patients with SLE. The results were as follows . 1) Incidences of a positive LBT were 84% in both involved and uninvolved skin and IgM was most frequently deposited(66% & 72%) in both, whereas IgA was least frequently deposited(34% & 19%) in both. 2) Deposits in DEJ of IgG, IgM, IgA and C were found with approximately same frequency in patients with different clinical manifestations and different laboratory findings. 3) Incidences of positive LBT in patients with renal disease were approximately same as in patients without renal disease. And deposits of all clssses of immuno glcbulins were found with about the same frequency in these two groups. 4) A positive LBT composed of IgG alone or IgG and other Igs were associated with an increase of anemia, ANA, anti-DNA and hypocomplementemia. Ten renal biopsies showed diffuse proliferative glomerulonephritis(GN) in focal proliferative GN in 3 and membranous CiN in 2 and no correlation to immune deposits.