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DIrect immunofluorescence ON plucked hair IN IMMUNOLOGICAL DISEASES of the skin

DIrect immunofluorescence ON plucked hair IN IMMUNOLOGICAL DISEASES of the skin.

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DIrect immunofluorescence ON plucked hair IN IMMUNOLOGICAL DISEASES of the skin

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  1. DIrectimmunofluorescence ON plucked hair IN IMMUNOLOGICAL DISEASES of the skin • Background: Direct immunofluorescence (DIF) is an indispensable diagnostic tool in immunological diseases and can also be used for monitoring the therapeutic response; some authors propose DIF on plucked hair in pemphigus vulgaris (PV) as an alternative for repetitive skin biopsies • Material and Method: • We studied 11 cases of immunological diseases: 6 cases of PV, 4 cases of lupus erythematosus (LE) and 1 case of bulous pemphigoid (BP) and we tried to evaluate the importance of DIF on plucked hair in diagnosis. • For every patient we analyzed: oneskin biopsy for paraffin, one skin biopsy for DIF and plucked hair from the scalp for DIF. Hematoxylin-eosin (HE) and DIF were performed on frozen section. In paraffin processing we used HE and special stains as Giemsa, PAS and Alcian Blue pH2,5. RazvanTheodor Andrei*, Adina Alexandru**, TiberiuTebeica*, Sabina Zurac*, FloricaStaniceanu*, Carmen Maria Salavastru**, SorinGeorge Tiplica**(Note: Andrei and Alexadru should be regarded as first authors in equal proportion) *Pathology Department, ** Dermatology Department, ColentinaUniversity Hospital, Bucharest

  2. Material and Method (cont.): In DIF we evaluated the expression of IgA, IgM, IgG, C3, C1q and fibrinogen • DIF was used both in cutaneous biopsies and hair follicle. • In one patient with PV, plucked hair from the inguinal and axilar area were analyzed as well as Tzank smears • In another patient with PV, telogen hair from “brush” was alsoanalyzed. Results • All but one patients were women. The BP patient was male.The mean age was 48.75 years (59.66 years in PV group). • In PV group • IgG and C3 were positive intercellular, in characteristic net-like pattern in both epidermis and outer sheath of hair follicle, with a weaker positivity for C3; • in inguinal and axilar hair IgG and C3 were positive too while in telogen hair from “brush” were negative • In LE and BP cases, DIF tests on plucked hair were negative

  3. Pemphigusvulgaris-73 years old female Pemphigusvulgaris- 43 years old female C3 plucked hair IgG skin biopsy IgG IgG C3 IgG plucked hair plucked hair C3

  4. IgG IgG Bulouspemphigoid - 63 years old male Lupus erythematosus-48 years old female plucked hair IgM IgG C3

  5. Conclusions • DIF (for IgG and C3) in PV has similar results in both plucked hair and skin biopsy → DIF of plucked hair could replace skin biopsy in diagnosis of pemphigusvulgaris • DIF on plucked hair was negative for IgG, IgM or C3 in LE and BP→ In lupus erythematosus and bulouspemphigoid, DIF of plucked hair has no diagnostic value

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