Perry David M, Wilson Ashley, Self Sally, Maize John C
Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, SC.
College of Medicine, Medical University of South Carolina, Charleston, SC; and.
Am J Dermatopathol. 2021 Jan 1;43(1):42-44. doi: 10.1097/DAD.0000000000001710.
Bullous pemphigoid (BP) is the most common autoimmune blistering disorder of the skin. It is typified by tense blisters with a subepidermal split and mixed dermal inflammatory infiltrate on histology. Biopsy of the perilesional skin for direct immunofluorescence (DIF) has become the gold standard in the diagnosis of BP. Currently there is a pervasive clinical opinion that the lower extremity is a site with a high false-negative rate (FNR) for DIF in the diagnosis of BP. This notion is primarily based on 2 early studies from the 1980s without more recent confirmatory studies. To readdress this question regarding the lower extremities, a retrospective study from 2012 to 2018 was performed in our institution that evaluated the FNR of DIF by an anatomical site in the diagnosis of BP. Cases of BP were identified using standard criteria (clinical and histological data reviewed in cases with negative DIF), and overall, 79 patients were included in the study. A total of 4 false-negative DIF biopsies were verified. Two negative DIF were from the lower extremity yielding a FNR of 10% compared with 4% on the trunk and 3% from the upper extremity, with no statistically significant difference by anatomical sites. Our study fails to demonstrate a high FNR of DIF from the lower extremity in the diagnosis of BP.
大疱性类天疱疮（BP）是最常见的皮肤自身免疫性水疱病。其典型表现为紧张性水疱，组织学上有表皮下裂隙和混合性真皮炎症浸润。对皮损周围皮肤进行活检以进行直接免疫荧光检查（DIF）已成为BP诊断的金标准。目前存在一种普遍的临床观点，即下肢是BP诊断中DIF假阴性率（FNR）较高的部位。这一观点主要基于20世纪80年代的两项早期研究，缺乏近期的证实性研究。为了重新探讨关于下肢的这个问题，我们机构进行了一项2012年至2018年的回顾性研究，评估了DIF在BP诊断中按解剖部位的FNR。使用标准标准（对DIF阴性病例的临床和组织学数据进行复查）来确定BP病例，总体上，79例患者纳入研究。共核实了4例假阴性DIF活检。两例假阴性DIF来自下肢，FNR为10%，而躯干为4%，上肢为3%，不同解剖部位之间无统计学显著差异。我们的研究未能证明下肢DIF在BP诊断中有较高的FNR。
