Accessible diagnostic methods to differentiate between epidermolysis bullosa acquisita and other subepidermal autoimmune bullous diseases

Abstract

[4] Following the aforementioned routine assays available in most immunopathological laboratories, the challenge is to differentiate between EBA, anti-p200 pemphigoid, and anti-laminin 332 MMP, because in all of these diseases, autoantibodies deposit on the floor of the artificial blister when IIF microscopy is performed on salt-split human skin. [7] demonstrated that type IV collagen was demonstrated in the epidermal roof of the blister whenever this immunohistochemical stain was reactive. Since the level of separation is identical in both EBA and DEB, it is conceivable that similar pattern will be observed in EBA. More sophisticated diagnostic approaches In those patients with inconclusive serration pattern and nonreactive type IV collagen immunostaining, who do not show serum reactivity against type VII collagen, the diagnosis of EBA may be made by fluorescence overlay antigen mapping technique or direct immunogold electron microscopy considered as the gold standard of diagnosis.