The Immunofluorescent "Band" Test for Lupus Erythematosus

Abstract

Clinically normal skin biopsies from 220 patients were tested by the direct fluorescent antibody technique for the "band" of localized immunoglobulins found at the dermal-epidermal junction in lupus erythematosus (LE) skin. Diseases studied included systemic lupus erythematosus (SLE), discoid lupus erythematosus (DLE), rheumatoid arthritis, scleroderma, and various miscellaneous dermatoses including bullous diseases. Only SLE and bullous pemphigoid demonstrated the band. The SLE band differed morphologically from that of bullous pemphigoid. The band-positive SLE patients had severer disease and a higher incidence of certain laboratory abnormalities associated with more severe SLE than the band negatives. Kidney involvement occurred three times, fever 3 1/2 times, and marked weight loss two times as frequently in the band positive patients. The presence of the band in clinically normal skin is, therefore, both diagnostic and probably prognostic, confirming a clinical diagnosis of SLE even in patients without LE skin lesions, and simultaneously suggesting a poorer prognosis.