Department of Dermatology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India.
Department of Community Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India.
Indian J Dermatol Venereol Leprol. 2021 Nov-Dec;87(6):778-786. doi: 10.25259/IJDVL_1232_20.
Serration pattern analysis helps in the classification of subepidermal autoimmune blistering disorders; more precisely, it helps to differentiate epidermolysis bullosa acquisita from other subepidermal autoimmune blistering disorders. Most of the published reports of this tool have come from a single center.
The objectives of the study were to study the utility of serration pattern analysis in classifying subepidermal autoimmune blistering disorders.
Seventy five cases of subepidermal autoimmune blistering disorders were enrolled in this prospective study. A three millimeter punch biopsy was taken from the perilesional skin or mucosa for direct immunofluorescence; indirect immunofluorescence was carried out using salt-split skin. Subclassification of subepidermal autoimmune blistering disorders was done based on direct immunofluorescence, indirect immunofluorescence on salt-split skin, indirect immunofluorescence using knockout skin and serration pattern analysis findings.
Indirect immunofluorescence was positive in 68 cases; 14 cases showed a dermal staining pattern while the rest showed either an epidermal or a combined pattern. All patients with epidermal or combined staining patterns showed "n" serrated pattern on direct immunofluorescence. Nine patients with dermal staining on indirect immunofluorescence also revealed an "n" serration pattern on direct immunofluorescence indicating the diagnosis of anti-p200 pemphigoid, and the rest showed a "u" serrated pattern. Three patients with negative indirect immunofluorescence showed "u" serration on direct immunofluorescence while the rest showed "n" serration.
ELISA and immunoblotting could not be performed due to resource constraints.
Based on indirect immunofluorescence and serration pattern analysis, classification of the majority of patients with subepidermal autoimmune blistering disorders was possible in our study. Pattern recognition is a cost-effective tool and can be easily learnt. It is recommended to be practiced in all laboratories where facilities for advanced immunological diagnosis are unavailable.
锯齿状分析有助于亚表皮自身免疫性水疱病的分类；更准确地说，它有助于将获得性大疱性表皮松解症与其他亚表皮自身免疫性水疱病区分开来。该工具的大多数已发表报告来自单一中心。
本研究的目的是研究锯齿状分析在分类亚表皮自身免疫性水疱病中的效用。
本前瞻性研究纳入了 75 例亚表皮自身免疫性水疱病患者。从病变周围皮肤或黏膜取 3 毫米活检进行直接免疫荧光检查；使用盐裂皮肤进行间接免疫荧光检查。根据直接免疫荧光、盐裂皮肤间接免疫荧光、敲除皮肤间接免疫荧光和锯齿状分析结果对亚表皮自身免疫性水疱病进行亚分类。
间接免疫荧光阳性 68 例；14 例显示真皮染色模式，其余均显示表皮或混合模式。所有具有表皮或混合染色模式的患者在直接免疫荧光检查中均显示“n”锯齿状模式。9 例间接免疫荧光显示真皮染色的患者在直接免疫荧光检查中也显示“n”锯齿状模式，提示诊断为抗 p200 天疱疮，其余患者显示“u”锯齿状模式。3 例间接免疫荧光阴性的患者在直接免疫荧光检查中显示“u”锯齿状模式，其余患者显示“n”锯齿状模式。
由于资源限制，无法进行 ELISA 和免疫印迹检查。
根据间接免疫荧光和锯齿状分析，我们的研究可以对大多数亚表皮自身免疫性水疱病患者进行分类。模式识别是一种具有成本效益的工具，并且易于学习。建议在没有高级免疫诊断设施的实验室中进行实践。
