Yeol Lee Ho, Ham Seung Pil, Choi Yoo Won, Park Hai-Jin
Hai-Jin Park, MD, Inje Univ. Ilsan Paik Hospital, 170 Juwha-Ro, Ilsanseo-gu, Goyang, Gyeonggi-do, Korea;
Acta Dermatovenerol Croat. 2018 Jun;26(2):133-138.
Autoimmune subepidermal bullous diseases (AISBDs) exhibit various clinical presentations, histological appearances, prognoses, and responses to treatment. Many diagnostic techniques, such as direct immunofluorescence (IF), indirect salt-split skin IF, and enzyme-linked immunosorbent assays, are used in the differential diagnoses of AISBDs. However, these techniques require fresh frozen tissue, expensive laboratory equipment, and sophisticated laboratory techniques. The purpose of this study was to evaluate the value of type IV collagen immunohistochemical (IHC) staining for the differential diagnosis of AISBDs. Paraffin-embedded blocks of skin biopsies were selected from 28 patients with autoimmune subepidermal bullous diseases. Among these 28 cases, 24 patients exhibited bullous pemphigoid (BP), 2 exhibited epidermolysis bullosa acquisita (EBA), 1 exhibited linear immunoglobulin A dermatosis (LAD), and 1 exhibited bullous systemic lupus erythematosus (BSLE). Sections were stained for type IV collagen and examined to determine the location of type IV collagen in the subepidermal blister. Type IV collagen positivity was observed on the base of the subepidermal blister in patients with BP (24 of 24 cases) and LAD (1 of 1 case). Staining was observed on the roof of the blister in patients with EBA (2 of 2 cases) and BSLE (1 of 1 case), and irregular staining was also observed on the base in patients with EBA. In conclusion, type IV collagen IHC staining is a simple and useful diagnostic technique for the differential diagnosis of AISBDs.
自身免疫性表皮下大疱病（AISBDs）具有多种临床表现、组织学表现、预后情况以及对治疗的反应。许多诊断技术，如直接免疫荧光（IF）、间接盐裂皮肤IF和酶联免疫吸附测定，被用于AISBDs的鉴别诊断。然而，这些技术需要新鲜冷冻组织、昂贵的实验室设备以及复杂的实验室技术。本研究的目的是评估IV型胶原免疫组织化学（IHC）染色在AISBDs鉴别诊断中的价值。从28例自身免疫性表皮下大疱病患者中选取皮肤活检的石蜡包埋块。在这28例病例中，24例表现为大疱性类天疱疮（BP），2例表现为获得性大疱性表皮松解症（EBA），1例表现为线状免疫球蛋白A皮病（LAD），1例表现为大疱性系统性红斑狼疮（BSLE）。切片进行IV型胶原染色，并检查以确定IV型胶原在表皮下疱中的位置。在BP患者（24例中的24例）和LAD患者（1例中的1例）的表皮下疱底部观察到IV型胶原阳性。在EBA患者（2例中的2例）和BSLE患者（1例中的1例）的疱顶观察到染色，并且在EBA患者的底部也观察到不规则染色。总之，IV型胶原IHC染色是一种用于AISBDs鉴别诊断的简单且有用的诊断技术。
