Department of Skin and VD, Kasturba Medical College, Manipal, Karnataka, India.
Int J Dermatol. 2009 Nov;48(11):1187-9. doi: 10.1111/j.1365-4632.2009.04153.x.
Direct immunofluorescence (DIF) of perilesional skin is the gold standard in the diagnosis of pemphigus. Since the outer root sheath (ORS) of anagen hair is structurally analogous to epidermal keratinocytes, pemphigus specific immunofluorescence pattern may be present in the ORS.
Twenty consecutive patients of pemphigus were enrolled in the study, irrespective of any other inclusion or exclusion criteria. Hairs were plucked in a similar fashion to that of trichogram. Approximately 5 anagen hairs were selected processed and stained with fluorescein isothiocyanate (FITC) conjugates. DIF of perilesional skin and indirect immunofluorescence (IIF) were carried out simultaneously. DIF of hair was also done in equal numbers of controls with other dermatoses.
Intercellular deposition of IgG was seen in the ORS of anagen hair in 85% of patients (n = 17). The test was positive in all patients who had scalp lesions (n = 10); however, it was also positive in 7 patients (77.7%) who did not have scalp lesions. The test was negative in 3 patients; two of whom were elderly and had sparse scalp hair. The other patient only had mucosal lesion. The test was negative in the control group.
DIF of hair is a simple, non-invasive test. In future, it may alleviate the need for skin biopsies, in patients with pemphigus.
病损周围皮肤的直接免疫荧光（DIF）是天疱疮诊断的金标准。由于生长期毛发的外根鞘（ORS）在结构上类似于表皮角朊细胞，因此可能存在天疱疮特异性免疫荧光模式。
本研究纳入了 20 例连续的天疱疮患者，无论是否存在任何其他纳入或排除标准。以类似拔发试验的方式拔取毛发。选择大约 5 根生长期毛发进行处理和荧光素异硫氰酸酯（FITC）缀合染色。同时进行病损周围皮肤的 DIF 和间接免疫荧光（IIF）。同样对其他皮肤病的对照组进行了等量的毛发 DIF 检测。
在 85%（n=17）的患者的生长期毛发 ORS 中观察到 IgG 的细胞间沉积。头皮病变的 10 例患者（n=10）中，该检测均为阳性；然而，7 例（77.7%）没有头皮病变的患者也为阳性。3 例患者的检测结果为阴性，其中 2 例为老年患者且头皮毛发稀疏，另 1 例仅患有黏膜病变。对照组的检测结果为阴性。
毛发的 DIF 是一种简单、非侵入性的检测方法。将来，它可能会减少天疱疮患者对皮肤活检的需求。
