Immunofluorescent Techniques in Clinical Diagnosis of Cutaneous Disease

The value of immunofluorescent techniques in the diagnosis of cutaneous diseases is illustrated by representative case reports. Specific staining patterns are seen in lupus erythematosus (LE), pemphigus vulgaris, and bullous pemphigoid. Skin specimens from 271 patients, 156 with LE, were examined by the direct immunofluorescent technique. Immunoglobulin deposition at the dermal-epidermal junction was noted in 92% of involved skin in systemic LE (SLE) and 88% in discoid LE (DLE). Clinically uninvolved skin in 56% of SLE patients was also positive. Sera from 325 patients were studied by indirect immunofluorescence with normal human skin as the antigenic substrate. Seventy-eight percent of SLE sera and 37% of DLE sera showed antinuclear antibodies to epidermal nuclei. In DLE this method appeared more sensitive than the leukocyte antinuclear antibody test. Antibodies to the basement membrane zone were seen only in bullous pemphigoid, and epidermal intercellular fluorescence was limited to pemphigus.