Diagnostic utility of direct immunofluorescence findings around hair follicles and sweat glands in immunobullous disease

Julia Lehman, Michael J. Camilleri

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background Inherent to some immunobullous disorders is potential for intraepidermal or dermal-epidermal junction fragility, a phenomenon that may compromise biopsy specimen integrity and direct immunofluorescence (DIF) interpretation. In these situations, cutaneous adnexal structures (e.g. hair follicles, sweat apparatus) usually remain intact. Whether periadnexal DIF findings are reliable in diagnosing immunobullous conditions is unknown. Methods We evaluated 56 cutaneous specimens with diagnostic immunoglobulin (Ig) deposition patterns that contained adnexal structures. In a corollary study, we examined 145 hematoxylin-eosin-stained frozen specimens to determine biopsy factors associated with the presence of adnexal structures. Results Periadnexal DIF findings offered diagnostic sensitivity in conditions with linear or cell-surface Ig deposition or lupus band. Periadnexal DIF findings were unreliable in dermatitis herpetiformis. Biopsy specimens from scalp and genitalia were most likely to contain folliculosebaceous units and sweat duct apparatus, respectively. Relative depth of biopsy correlated directly with the likelihood of identifying sweat duct apparatus but not folliculosebaceous units. Conclusions Periadnexal DIF findings may add diagnostic sensitivity in DIF evaluation of pemphigoid, pemphigus and lupus erythematosus. Pathologists can guide clinicians to biopsy certain anatomic sites and to obtain sufficient biopsy depth to increase the probability of capturing adnexal structures and, therefore, diagnostic yield from DIF specimens.

Original languageEnglish (US)
Pages (from-to)230-235
Number of pages6
JournalJournal of Cutaneous Pathology
Volume40
Issue number2
DOIs
StatePublished - Feb 1 2013

Fingerprint

Sweat Glands
Direct Fluorescent Antibody Technique
Hair Follicle
Biopsy
Sweat
Skin
Dermatitis Herpetiformis
Bullous Pemphigoid
B-Cell Antigen Receptors
Genitalia
Pemphigus
Hematoxylin
Eosine Yellowish-(YS)
Scalp
Immunoglobulins

Keywords

  • adnexal diseases
  • hair follicle
  • immunobullous disorders
  • immunofluorescence technique
  • sweat glands

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Histology
  • Dermatology

Cite this

Diagnostic utility of direct immunofluorescence findings around hair follicles and sweat glands in immunobullous disease. / Lehman, Julia; Camilleri, Michael J.

In: Journal of Cutaneous Pathology, Vol. 40, No. 2, 01.02.2013, p. 230-235.

Research output: Contribution to journalArticle

@article{38782038ddbd4c9ba3aaf8e97c13e97c,
title = "Diagnostic utility of direct immunofluorescence findings around hair follicles and sweat glands in immunobullous disease",
abstract = "Background Inherent to some immunobullous disorders is potential for intraepidermal or dermal-epidermal junction fragility, a phenomenon that may compromise biopsy specimen integrity and direct immunofluorescence (DIF) interpretation. In these situations, cutaneous adnexal structures (e.g. hair follicles, sweat apparatus) usually remain intact. Whether periadnexal DIF findings are reliable in diagnosing immunobullous conditions is unknown. Methods We evaluated 56 cutaneous specimens with diagnostic immunoglobulin (Ig) deposition patterns that contained adnexal structures. In a corollary study, we examined 145 hematoxylin-eosin-stained frozen specimens to determine biopsy factors associated with the presence of adnexal structures. Results Periadnexal DIF findings offered diagnostic sensitivity in conditions with linear or cell-surface Ig deposition or lupus band. Periadnexal DIF findings were unreliable in dermatitis herpetiformis. Biopsy specimens from scalp and genitalia were most likely to contain folliculosebaceous units and sweat duct apparatus, respectively. Relative depth of biopsy correlated directly with the likelihood of identifying sweat duct apparatus but not folliculosebaceous units. Conclusions Periadnexal DIF findings may add diagnostic sensitivity in DIF evaluation of pemphigoid, pemphigus and lupus erythematosus. Pathologists can guide clinicians to biopsy certain anatomic sites and to obtain sufficient biopsy depth to increase the probability of capturing adnexal structures and, therefore, diagnostic yield from DIF specimens.",
keywords = "adnexal diseases, hair follicle, immunobullous disorders, immunofluorescence technique, sweat glands",
author = "Julia Lehman and Camilleri, {Michael J.}",
year = "2013",
month = "2",
day = "1",
doi = "10.1111/cup.12037",
language = "English (US)",
volume = "40",
pages = "230--235",
journal = "Journal of Cutaneous Pathology",
issn = "0303-6987",
publisher = "Wiley-Blackwell",
number = "2",

}

TY - JOUR

T1 - Diagnostic utility of direct immunofluorescence findings around hair follicles and sweat glands in immunobullous disease

AU - Lehman, Julia

AU - Camilleri, Michael J.

PY - 2013/2/1

Y1 - 2013/2/1

N2 - Background Inherent to some immunobullous disorders is potential for intraepidermal or dermal-epidermal junction fragility, a phenomenon that may compromise biopsy specimen integrity and direct immunofluorescence (DIF) interpretation. In these situations, cutaneous adnexal structures (e.g. hair follicles, sweat apparatus) usually remain intact. Whether periadnexal DIF findings are reliable in diagnosing immunobullous conditions is unknown. Methods We evaluated 56 cutaneous specimens with diagnostic immunoglobulin (Ig) deposition patterns that contained adnexal structures. In a corollary study, we examined 145 hematoxylin-eosin-stained frozen specimens to determine biopsy factors associated with the presence of adnexal structures. Results Periadnexal DIF findings offered diagnostic sensitivity in conditions with linear or cell-surface Ig deposition or lupus band. Periadnexal DIF findings were unreliable in dermatitis herpetiformis. Biopsy specimens from scalp and genitalia were most likely to contain folliculosebaceous units and sweat duct apparatus, respectively. Relative depth of biopsy correlated directly with the likelihood of identifying sweat duct apparatus but not folliculosebaceous units. Conclusions Periadnexal DIF findings may add diagnostic sensitivity in DIF evaluation of pemphigoid, pemphigus and lupus erythematosus. Pathologists can guide clinicians to biopsy certain anatomic sites and to obtain sufficient biopsy depth to increase the probability of capturing adnexal structures and, therefore, diagnostic yield from DIF specimens.

AB - Background Inherent to some immunobullous disorders is potential for intraepidermal or dermal-epidermal junction fragility, a phenomenon that may compromise biopsy specimen integrity and direct immunofluorescence (DIF) interpretation. In these situations, cutaneous adnexal structures (e.g. hair follicles, sweat apparatus) usually remain intact. Whether periadnexal DIF findings are reliable in diagnosing immunobullous conditions is unknown. Methods We evaluated 56 cutaneous specimens with diagnostic immunoglobulin (Ig) deposition patterns that contained adnexal structures. In a corollary study, we examined 145 hematoxylin-eosin-stained frozen specimens to determine biopsy factors associated with the presence of adnexal structures. Results Periadnexal DIF findings offered diagnostic sensitivity in conditions with linear or cell-surface Ig deposition or lupus band. Periadnexal DIF findings were unreliable in dermatitis herpetiformis. Biopsy specimens from scalp and genitalia were most likely to contain folliculosebaceous units and sweat duct apparatus, respectively. Relative depth of biopsy correlated directly with the likelihood of identifying sweat duct apparatus but not folliculosebaceous units. Conclusions Periadnexal DIF findings may add diagnostic sensitivity in DIF evaluation of pemphigoid, pemphigus and lupus erythematosus. Pathologists can guide clinicians to biopsy certain anatomic sites and to obtain sufficient biopsy depth to increase the probability of capturing adnexal structures and, therefore, diagnostic yield from DIF specimens.

KW - adnexal diseases

KW - hair follicle

KW - immunobullous disorders

KW - immunofluorescence technique

KW - sweat glands

UR - http://www.scopus.com/inward/record.url?scp=84872725342&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84872725342&partnerID=8YFLogxK

U2 - 10.1111/cup.12037

DO - 10.1111/cup.12037

M3 - Article

VL - 40

SP - 230

EP - 235

JO - Journal of Cutaneous Pathology

JF - Journal of Cutaneous Pathology

SN - 0303-6987

IS - 2

ER -