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Giornale Italiano di Dermatologia e Venereologia 2002 December;137(6):383-93

Copyright © 2002 EDIZIONI MINERVA MEDICA

language: English

Laboratory diagnosis of autoimmune bullous diseases

Mutasim D. F.

Department of Dermatology University of Cincinnati, Cincinnati, OH, USA


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The classification of autoimmune bullous diseases has changed remarkably during the past few decades due to the progress in understanding the biology of adhesion molecules within the epidermis and dermal-epidermal junction. Specific molecules in these compartments are the target for the immune response in the various autoimmune bullous diseases. Vesicle formation results from the binding of autoantibodies to adhesion molecules that result in disruption of the integrity of the epidermis (pemphigus) or dermal-epidermal junction (subepidermal bullous diseases). Inflammation plays a significant role in the pathogenesis of subepidermal bullous diseases. The accurate diagnosis of autoimmune bullous diseases depends on clinical examination, histological examination, direct immunofluorescence, indirect immunofluorescence and rarely other immunological techniques such as ELISA, immunoprecipitation and Western blotting. Histological examination is more helpful in the diagnosis of the various types of pemphigus than in subepidermal bullous diseases. In the latter group, there is overlap in the histologic findings among the various diseases, and direct immunofluorescence is essential in the differential diagnosis. Indirect immunofluorescence is helpful in confirming a suspected diagnosis as well as in differentiating among closely related disorders such as bullous pemphigoid and epidermolysis bullosa acquisita. It may also be helpful in monitoring the immunological response of the disease to therapy.

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