Abstract:
BACKGROUND:It has been postulated that periodic acid-Schiff staining of basement membrane can predict direct immunofluorescence patterns seen in epidermolysis bullosa acquisita and bullous pemphigoid. It has also been suggested that the type of inflammatory infiltrate or presence of fraying of basal keratinocytes may differentiate these two conditions. OBJECTIVE:In this study, we aimed to confirm these observations. METHODS:We reviewed 13 cases of direct immunofluorescence-confirmed epidermolysis bullosa acquisita and 19 cases of direct immunofluorescence-confirmed bullous pemphigoid, all with a subepidermal blister in the routinely processed specimen. The gold standard for diagnosis of epidermolysis bullosa acquisita vs bullous pemphigoid was taken to be identification of immune deposits on the dermal side ('floor' for epidermolysis bullosa acquisita) or the epidermal side ('roof' for bullous pemphigoid) of the salt-split direct immunofluorescence specimen. Our tests to distinguish epidermolysis bullosa acquisita from bullous pemphigoid on the routinely processed biopsy included periodic acid-Schiff basement membrane on the blister roof, neutrophilic infiltrate, lack of eosinophilic infiltrate, and absence of keratinocyte fraying. RESULTS:Sensitivity and specificity for each test were as follows: periodic acid-Schiff staining of roof (sensitivity 25%, specificity 95%), neutrophilic infiltrate (sensitivity 54%, specificity 74%), lack of eosinophilic infiltrate (sensitivity 92%, specificity 68%), and absence of keratinocyte fraying (sensitivity 62%, specificity 58%). CONCLUSIONS:Features in the routinely processed biopsy were unable to reliably distinguish between epidermolysis bullosa acquisita and bullous pemphigoid. Direct immunofluorescence on salt-split skin remains the standard for differentiation.
journal_name
J Cutan Med Surgjournal_title
Journal of cutaneous medicine and surgeryauthors
Gardner KM,Crawford RIdoi
10.1177/1203475417722734subject
Has Abstractpub_date
2018-01-01 00:00:00pages
22-24issue
1eissn
1203-4754issn
1615-7109journal_volume
22pub_type
杂志文章abstract:OBJECTIVE:To better understand cutaneous photosensitivity reactions, a review of its etiologic factors, clinical characteristics, pathogenesis, and treatment modalities was undertaken. METHODS:Articles discussing the above aspects of phototoxic and photoallergic reactions were used to demonstrate what is currently kno...
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