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Title: Analysis of the results of direct immunofluorescence tests in bullous pemphigoid patients who were diagnosed at the Wrocław Department of Dermatology in years 2005-2008.

Rafał Białynicki-Birula, Anna Wojnowska, Tomasz Kołodziej
Original articles
Clinical Dermatology
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Final page:
bullous pemphigoid, immunoglobulins, complement, fluorescent antibody techniques, diagnosis

Introduction: Bullous pemphigoid (BP) is one of the autoimmunological blister diseases. The main criteria for diagnosis are: clinical features, histological features, direct immunofluorescence test (DIF) and serological tests to reveal autoantibodies against BP antigens, which are the structures of hemidesmosomes. The deposits of immunoglobulins and/or complement components are shown at the basement membrane zone (BMZ) in DIF of BP patients. Aim of study was to determine which immunoglobulins and/or complement components are the most specific and which of them are not significant. The next aim was to compare the results from this study - patients from the period: 2005-2008, to the results from years 1986-2000. Material and methods: 61 patients (43 women and 18 men) with BP were enrolled to the study. The patients were treated at the Wroclaw Department of Dermatology in years 2005-2008 (4 years). Routine determination of DIF was applied to show the depositis of immunoglobulins: IgG, IgA i IgM and complement components: C1q and C3c. Biopsy were taken from the perilesional skin, about 1 cm from infiltrated lesion or blister. The presence of linear depositis of IgG and/or C3c and/or C1q at the BMZ were treated as positive result. Results: Deposits of C3c at the BMZ in characteristic linear pattern were found in 49 BP patients (80.3%). There were the most frequent revealed kind of deposits. Deposits of C1q were shown in 39 (63.9%) patients, IgG in 28 (45.9%), IgA in 7 (11.5%) and IgM in 24 (39.3%). Deposits of IgG were accompanied by C3c in 22 (36.1%) patients, and by C1q in 18 (29.5%), and by both - C1q and C3c in 17 (27.9%) patients. Deposits of IgG and/or C3c were revealed in 55 (90.2%), IgG and/or C1q in 49 (80.3%) and IgG and/or C1q and/or C3c in all patients (100.0%). Conclusions: 1. Deposits of C3c at the BMZ in characteristic linear pattern were found in 49 (80.3%) and IgG in 28 (45.9%) BP patients. The results from years 1986-2000 were as follows: 65.8% i 60.9%. 2. The presence of C1q deposits were revealed in 65,1% BP patients. DIF (IgG and/or C3) were positive for 90% and thanks to addition of assessment of C1q were significantly higher. DIF (IgG and/or C3 and/or C1q) were positive for all patients (100%). 3. Deposits of IgA and/or IgM occured always in the presence with others deposits: IgG and/or C1q and/or C3.