The use of immunofluorescent techniques in dermatology.

The purpose of this paper is to show (1) the use and limitations of the techniques involved in immunofluorescent procedures, (2) to describe the skin diseases in which immunofluorescence is of diagnostic or therapeutic value and (3) to review our experience over the past two years. There are many skin diseases in which diagnosis can be difficult at a histopathological level, let alone for the clinician. Immunofluorescence is particularly of value in establishing the diagnosis in the members of the bullous skin diseases, e.g. pemphigus, pemphigoid, dermatitis herpetiformis and benign mucous membrane pemphigoid. In classical pemphigus with a representative, early lesion, the typical features usually are present but not infrequently the diagnosis can be exceedingly difficult, particularly with old lesions, and especially if they have become secondarily infected. In such instances immunofluorescent studies can be crucial to establish the correct diagnosis. Bullous pemphigoid, dermatitis herpetiformis and benign mucous membrane pemphigoid have essentially similar microscopic features they are all typified by the presence of a sub-epidermal vesicle. Although distinguishing features do exist, they are not always present and, thus, immunofluorescence can often resolve the problem. Immunofluorescent studies are essential in patients suffering from discoid and systemic lupus erythematosus. They are occasionally of value in establishing the diagnosis of a vasculitis.