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Mayo Clinic Atlas of Immunofluorescence in Dermatology: Patterns and Target Antigens

2006 Edition, March 30, 2006

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ISBN: 978-0-8493-7572-9
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Product Details:

  • Revision: 2006 Edition, March 30, 2006
  • Published Date: March 30, 2006
  • Status: Active, Most Current
  • Document Language: English
  • Published By: CRC Press (CRC)
  • Page Count: 77
  • ANSI Approved: No
  • DoD Adopted: No

Description / Abstract:

Preface

This atlas reviews the different immunofluorescence patterns for various dermatologic conditions through the use of photographs, brief descriptions, tables, and flowcharts. Some important aspects of immunofluorescence are described in the following paragraph.

Immunofluorescence testing is important for diagnosing immunobullous diseases, connective tissue diseases, and vasculitis. Direct immunofluorescence involves the overlay of fluorescein-conjugated antibodies (IgG, IgM, IgA), complement (C3), and fibrinogen onto frozen sections of tissue obtained from patients. Biopsy specimens for direct immunofluorescence in immunobullous disease should be taken from perilesional normalappearing skin within a few millimeters of the edge of the blister. Obtaining a biopsy specimen from the blister or too close to the blister can result in a false-negative finding. This result is especially possible when dealing with mucosal surfaces because they are already prone to epithelial detachment. However, when a biopsy specimen is needed for diagnosis of connective tissue disease or vasculitis, a lesional biopsy is optimal.

Indirect immunofluorescence studies involve the detection of circulating autoantibodies in the patient's serum which target specific antigens in the patient's skin or mucosa. The technique for indirect immunofluorescence is helpful in immunobullous diseases. It involves incubating the patient's serum, which contains the autoantibodies, with frozen sections of epithelial substrate. The substrate is usually monkey esophagus, but pig esophagus also has been used. Rat bladder is used to rule out paraneoplastic pemphigus. After washing, fluoroscein-labeled animal anti-IgG conjugate against human immunoglobulin, such as IgG, is added. This fluoroscein-labeled animal conjugate binds to the patient's circulating IgG, which is already bound to the target antigen on the epithelial surface. Indirect immunofluorescence allows titration of the patient's serum to determine the highest titration yielding visible fluorescence. In cases of pemphigus, the titer of these autoantibodies correlates with disease activity.

This atlas systematically reviews the different immunofluorescence patterns found in immunodermatology for various immunobullous diseases, connective tissue diseases, vasculitis, and some miscellaneous conditions such as porphyria and lichenoid reactions. In addition, the direct and indirect immunofluorescence findings and the target antigens the autoantibodies bind to in various diseases are summarized in an easy-to-follow table.

I hope that this atlas will aid in understanding the different immunofluorescence patterns in many dermatology conditions. This atlas should be used by dermatologists, pathologists, residents, fellows, and medical students who obtain immunofluorescence results from patients. This atlas also will be a valuable resource for dermatology and pathology residents preparing for board examinations and is dedicated to all persons who have an interest in immunodermatology.

Immunodermatology has a long and rich tradition at Mayo Clinic, and I thank all my mentors in immunodermatology. You have inspired and taught, and I hope this atlas will help inspire the next generation of immunodermatologists. It has been a pleasure and a privilege to work with all my distinguished colleagues in dermatology at Mayo Clinic. Thank you for your teaching, mentoring, and friendship. I am grateful to my co-author and friend, Marie Nicolas, for her significant contributions to this atlas.

I especially thank my family for their love and support, which I cherish above all else. To my late father, I miss you and I thank you for your wisdom and continued inspiration.