Korean J Clin Pathol.  1998 Dec;18(4):608-613.

Indirect Immunofluorescent (IIF) Test for Circulating Anti-Skin Antibody: Using Salt Split Human Skin Substrate

• Kim SG
• Choe JY
• Kim DS

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.

Keyword

Salt split human skin; ASA; Anti-ICS Ab; Anti-BMZ Ab; SLE; Bullous disease

MeSH Terms

Antibodies
Blister
Dermatitis
Diagnosis
Fluorescein
Humans*
Immunoglobulin G
Immunoglobulin M
Lupus Erythematosus, Discoid
Lupus Erythematosus, Systemic
Membranes
Microscopy
Pemphigoid, Bullous
Pemphigus
Skin*
Sodium Chloride
Antibodies
Fluorescein
Immunoglobulin G
Immunoglobulin M
Sodium Chloride