Intercellular, Linear Direct Immunofluorescence Staining Pattern of Sweat Glands and Hair Follicles may be Used as a Diagnostic Marker for Pemphigus Vulgaris in Cases where Epidermis is Missing

Authors

  • Orsolya N. Horvath Department of Dermatology and Allergy, LMU University Hospital, Munich, Germany
  • Michaela Maurer Department of Dermatology and Allergy, LMU University Hospital, Munich, Germany
  • Vivian Wietzke Department of Dermatology and Allergy, LMU University Hospital, Munich, Germany
  • Victoria Fischer Department of Dermatology and Allergy, LMU University Hospital, Munich, Germany
  • Lars E. French Department of Dermatology and Allergy, LMU University Hospital, Munich, Germany; Dr. Phillip Frost, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
  • Miklós Sárdy Department of Dermatology and Allergy, LMU University Hospital, Munich, Germany; Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary

DOI:

https://doi.org/10.2340/actadv.v104.40620

Keywords:

direct immunofluorescence, hair follicles, pemphigus vulgaris, sebaceous glands, sweat glands

Abstract

Due to its rarity, it takes months for patients to be correctly diagnosed with pemphigus vulgaris. This delay can be exacerbated by factors such as incorrect biopsy site selection. When the epidermis detaches from the dermis, evaluating fluorescence patterns is impossible. This monocentric, retrospective study aimed to assess the clinical significance of the honeycomb-like staining pattern of adnexal structures in patients with pemphigus vulgaris. The study was conducted in Munich, from 1 January 2012 to 31 December 2020. Forty-four biopsy samples for direct immunofluorescence microscopy from pemphigus patients along with 44 samples from control patients were included. The fluorescence intensity of adnexal structures did not differ significantly from that of the epidermis in pemphigus, except for hair follicles and sweat glands with C3 staining, where the epidermis showed stronger fluorescence. The sensitivity for the characteristic fluorescence pattern of at least 1 adnexal structure was 88.64% (n = 39/44, 95% CI 75.44% to 96.21%), with 100% specificity. The positive predictive value of adnexal fluorescence was 100%, and the negative predictive value was 89.8%. It was found that the honeycomb-like staining pattern of sweat glands, sweat gland ducts, and hair follicles is a highly specific marker for pemphigus vulgaris.

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Published

2024-11-13

How to Cite

Horvath, O. N., Maurer, M., Wietzke, V., Fischer, V., French, L. E., & Sárdy, M. (2024). Intercellular, Linear Direct Immunofluorescence Staining Pattern of Sweat Glands and Hair Follicles may be Used as a Diagnostic Marker for Pemphigus Vulgaris in Cases where Epidermis is Missing. Acta Dermato-Venereologica, 104, adv40620. https://doi.org/10.2340/actadv.v104.40620

Issue

Vol. 104 (2024)

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Copyright (c) 2024 Orsolya N. Horvath, Michaela Maurer, Vivian Wietzke, Victoria Fischer, Lars E. French, Miklós Sárdy

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All digitalized ActaDV contents is available freely online. The Society for Publication of Acta Dermato-Venereologica owns the copyright for all material published until volume 88 (2008) and as from volume 89 (2009) the journal has been published fully Open Access, meaning the authors retain copyright to their work.

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