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CLINICAL REPORT
Diagnostic Value of Linear Fluorescence Along the Basement
Membrane of Sweat Gland Ducts in Bullous Pemphigoid
Işın SINEM BAĞCI 1,2 , Orsolya N. HORVÁTH 1 , Enno SCHMIDT 3,4 , Thomas RUZICKA 1 and Miklós SÁRDY 1
1
Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany, 2 Department of Dermatology, Ankara 29 Mayıs
Government Hospital, Ankara, Turkey, 3 Department of Dermatology, Allergology, and Venereology and 4 Lübeck Institute of Experimental
Dermatology (LIED), University of Lübeck, Lübeck, Germany
Linear IgG deposits along the basement membrane of
adnexa has been proposed to be useful in the diagno-
sis of bullous pemphigoid (BP), but no controlled stu-
dies have been performed. This study evaluated linear
IgG fluorescence of the basement membrane of sweat
gland ducts (SGD) and other adnexa in perilesional
biopsies from patients with BP (n = 64) and controls
(n = 82), using direct immunofluorescence microscopy.
Fluorescence intensity was graded semi-quantitatively.
Positive SGDs were found in 58 (90.6%) patients with
BP and 44 (53.7%) controls, a statistically significant
difference (p <
0.0001). The sensitivity of positive
SGDs for BP was high (90.6%), but the specificity was
low (46.3%). Only strong fluorescence intensity was
associated with high specificity. In conclusion, positive
SGDs in direct immunofluorescence microscopy are
highly sensitive for BP; however, only strong fluorescen-
ce has acceptable specificity. Weak positivity of SGDs
without linear fluorescence of the epidermal basement
membrane may not be sufficiently specific for BP.
Key words: bullous pemphigoid; sweat gland ducts; immuno
fluorescence; diagnostics.
Accepted Jan 12, 2017; Epub ahead of print Jan 17, 2017
Acta Derm Venereol 2017; 97: 622–626.
Corr: Işın Sinem Bağcı, Department of Dermatology and Allergology,
Ludwig-Maximilian University, Frauenlobstr. 9–11, DE-80337 Munich,
Germany. E-mail: [email protected]
B
ullous pemphigoid (BP) is the most common auto
immune blistering disease of the skin. Diagnosis of
BP relies on histopathological examination, including
direct immunofluorescence microscopy (DIF) on peri-
lesional skin biopsy specimens, in addition to detection
of circulating autoantibodies by indirect immunofluo-
rescence microscopy and enzyme-linked immunoassays
(ELISAs) (1, 2).
DIF is a specific, and the most sensitive, diagnostic
test for BP (3, 4). It rev