The purpose of this study was to develop a practical technique to distinguish autoimmune sub-epidermal bullous diseases.The authors present a prospective study from an academic referral center. The patient population consisted of forty-two patients fulfilling clinical, immunological, and/or immunoelectron microscopic criteria for bullous pemphigoid (n = 31), mucous membrane pemphigoid (n = 6), or epidermolysis bullosa acquisita (n = 5), diagnosed as having disease and treated from January 1, 1997, to December 31, 2002. Laser scanning confocal microscopy was applied to determine the localization of in vivo-bound IgG at the basement membrane zone in biopsy specimens taken front patients' skin to compare the localization of basement membrane zone markers: antibody against beta4 integrin, antibody against laminin 5, and antibody against type IV collagen. In vivo-bound IgG was visualized by labeling with fluorescein isothiocyanate-conjugated anti-human IgG antibody, whereas basement membrane zone markers were labeled with anti-mouse Cy5-conjugated antibodies. The authors' results present patients with bullous pemphigoid who have in vivo-bound IgG localized on the epidermal side of laminin 5 co-localized with beta4 integrin. In patients with mucous membrane pemphigoid, IgG was in vivo-bound to the dermalepidermal junction between localization of laminin 5 and type IV collagen. In patients with epidermolysis bullosa acquisita, in vivo-bound IgG was present on the dermal side of type IV collagen.
JDD Article Evaluation
The confocal microscope was actually developed for in-vivo imaging to reduce the number of biopsies, but this article presents ex-vivo use of the confocal microscope. In the past it has been used for Mobs surgery to bypass the tissue preparation, but the technique of basement membrane antibodies to biopsied skin is a novel approach to differentiating these blistering disorders in a timely fashion. Unfortunately, because of the prohibitive cost of the machine I see minimal use of this technique for the time being. Furthermore, during my research With the confocal microscope I found it more useful to compare my analysis of the lesions examined with a dermatopathologist trained in confocal imaging.
Wozniak K, Kazama T, Kowalewski C. Arch Dermatol 2003 Aug; 139(8):1007-11.
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