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Diagnosis of autoimmune subepidermal bullous diseases with mucous membrane involvement based on laser-scanning confocal microscopy

  • Investigative Report
  • Published:
European Journal of Dermatology

Abstract

Background

Mucosal involvement in autoimmune subepidermal blistering disorders (ASBD) may represent the only or predominant localization. Circulating autoantibodies are detected in 50% cases.

Objective

The aim of this study was to evaluate the usefulness of fluorescence overlay antigen mapping by laser-scanning confocal microscopy (FOAM-LSCM) to identify ASBD with mucosal involvement in oral mucosa specimens.

Materials & Methods

Thirty-two ASBD patients, diagnosed based on direct immunofluorescence between 2006 and 2016, were enrolled. Localization of IgG deposits bound at the basement membrane zone, relative to laminin-332 and collagen IV localization, was assessed in vivo.

Results

FOAM-LSCM disclosed four different immunofluorescence patterns. IgG deposits were located above laminin-332, as in bullous pemphigoid (BP-type), in 19% cases and co-localized with laminin-332 (anti-laminin-332-type) in 6% cases. IgG deposits were found below laminin-332 and above collagen IV (mucous membrane pemphigoid-type) in 59% cases, and below collagen IV (epidermolysis bullosa acquisita-type) in 16%. Circulating antibodies were found in 56% cases.

Conclusion

The FOAM-LSCM method should be used in order to obtain a definitive diagnosis of ASBD with mucosal involvement, particularly in the presence of negative circulating antibodies

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Author information

Authors and Affiliations

  1. Department of Dermatology and Immunodermatology, Medical University of Warsaw, Warsaw, Poland

    Katarzyna Wozniak, Beata Jakubowska, Agnieszka Kalinska-Bienias & Cezary Kowalewski

  2. Department of Dermatology, Osaka City University Graduate School of Medicine, Osaka, Japan

    Takashi Hashimoto

  3. Department of Dermatology, Kurume University School of Medicine, Kurume, Japan

    Norito Ishii

Authors
  1. Katarzyna Wozniak
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  2. Beata Jakubowska
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  3. Agnieszka Kalinska-Bienias
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  4. Takashi Hashimoto
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  5. Norito Ishii
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  6. Cezary Kowalewski
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Corresponding author

Correspondence to Agnieszka Kalinska-Bienias.

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Disclosures

Financial support: this work was supported by a grant from the National Centre of Science, Poland (no.NN402 661940). Conflicts of interest: none.

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Wozniak, K., Jakubowska, B., Kalinska-Bienias, A. et al. Diagnosis of autoimmune subepidermal bullous diseases with mucous membrane involvement based on laser-scanning confocal microscopy. Eur J Dermatol 30, 516–523 (2020). https://doi.org/10.1684/ejd.2020.3765

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  • DOI: https://doi.org/10.1684/ejd.2020.3765

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