Indirect Immunofluorescent (IIF) Test for Circulating Anti-Skin Antibody: Using Salt Split Human Skin Substrate.
- Author:
Sang Gyung KIM
1
;
Jung Yoon CHOE
;
Dong Seok KIM
Author Information
1. Department of Clinical Pathology, School of Medicine, Catholic University of Taegu-Hyosung, Taegu, Korea.
- Publication Type:Original Article
- Keywords:
Salt split human skin;
ASA;
Anti-ICS Ab;
Anti-BMZ Ab;
SLE;
Bullous disease
- MeSH:
Antibodies;
Blister;
Dermatitis;
Diagnosis;
Fluorescein;
Humans*;
Immunoglobulin G;
Immunoglobulin M;
Lupus Erythematosus, Discoid;
Lupus Erythematosus, Systemic;
Membranes;
Microscopy;
Pemphigoid, Bullous;
Pemphigus;
Skin*;
Sodium Chloride
- From:Korean Journal of Clinical Pathology
1998;18(4):608-613
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: Immunofluorescent test (IF) is the mainstay of diagnosis for autoimmune blistering diseases. The salt split skin (SSS) techniques, which artificially create a blister through the lamina lucida can often clarify the diagnosis in most cases. The titer of antibodies in the sera of patients is in many instances proportional to the severity of the disease. So, indirect immunofluorescent test can afford a useful aid in their management. METHODS: Skin antigen was prepared from normal human skin which was treated with 1.0 M sodium chloride solution and sectioned at 4-6 m on cryostat. The skin sections were incubated with the patients' sera in varying dilutions, washed, and then incubated with fluorescein tagged anti-human IgG and IgM. The sections were washed again and viewed under epi-fluorescence microscopy. We tested the sera from patients with discoid lupus erythematosus (dLE, n=1), pemphigus vulgaris (PV, n=3), bullous pemphigoid (BP, n=2), photosensitive dermatitis (PSD, n=1), systemic lupus erythematosus (SLE, n=11) and normal individuals (n=6). RESULTS: Anti-skin antibody (ASA) was positive in 17 out of 18 patients by the SSS technique and negative in one photosensitive dermatitis and all of the healthy normal controls. Among the 17 ASA-positive patients, 3 patients with PV had anti-intercellular substance (ICS) antibodies, 13 patients who are 11 patients with SLE and 2 with BP had anti-basement membrane zone (BMZ) antibodies and one patient with dLE had both of the antibodies. We found three types of anti-BMZ antibody IIF patterns along split sites, i.e. dermal type (1 of 11 SLE), epidermal type (5 of 11 SLE, 2 of BP) and combined type (5 of 11 SLE, 1 dLE). All of the SLE patients had IgM anti-BMZ, by contrast 2 BP patients had IgG anti-BMZ. CONCLUSIONS: Our study suggests that indirect IF test for circulating ASA using SSS is very useful for diagnosing autoimmune bullous disease and distinguishing the type of ASA.
