Patterns of direct immunofluorescence in sub-epidermal autoimmune bullous diseases of skin in Lahore, Pakistan

Background Autoimmune subepidermal blistering diseases are common in dermatological practice. Direct immunofluorescence study is considered gold standard for the diagnosis of this group. Objective This study was conducted to determine the patterns of direct immunofluorescence in subepidermal autoimmune bullous diseases of skin in Lahore, Pakistan. Patients and methods During a period of 6 months, 26 (14 males and 12 females) patients of subepidermal autoimmune bullous diseases were recorded. Histopathology and direct immunofluorescence were performed in all of these patients. Results Immunostaining at the dermo-epidermal junction was seen in all cases. The patterns on DIF in different diseases were: bullous pemphigoid (n=14) linear deposits of IgG (100%) and C3 (71.4%); dermatitis herpetiformis (n=4), granular deposits of only IgA (100%); linear IgA disease (n=5), linear deposit of IgA (100%) and C3 (20%); pemphigoid gestationis (n=2), linear deposits of IgG (100%) and C3 (100%); and bullous lupus erythematosus (n=1), linear deposit of IgG, IgA and IgM (100% each). No case of cicatricial pemphigoid or epidermolysis bullosa acquisita was seen. Conclusion DIF patterns in most of them especially in LAD and DH, were very specific, but in others clinical help was necessary to reach at the exact diagnosis as in pemphigoid gestationis and bullous LE.