Indirect Cutaneous Immunofluorescence

Abstract

Sera of 476 patients with bullous diseases, internal malignancies, and connective tissue diseases were tested for the bullous pemphigoid "band" and pemphigus epidermal intercellular fluorescence (ICF) by the indirect fluorescent antibody technique. Human skin cryostat sections were employed. The "band" was seen essentially only in bullous pemphigoid and its morphology was "tubular." Intercellular fluorescence was seen mainly in pemphigus. Positive, direct ICF and bands were seen in lesions of some indirect-negative pemphigus and bullous pemphigoid patients. Direct tests should thus be performed in patients strongly suspected of having pemphigus or bullous pemphigoid if the indirect test is negative. Epidermal nuclear immunofluorescence, particularly the peripheral pattern, often closely resembled ICF and had to be differentiated from it. Awareness of any antinuclear antibody activity in the sera tested is essential for accurate interpretation of this test which was found to be diagnostically extremely valuable.