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Skin and Mucosal Biopsies

Guidelines for Diagnosis of Autoimmune Bullous and Collagen Vascular Diseases


Combined direct immunofluorescence (DIF) and serum studies yield maximal diagnostic sensitivity and specificity. For most autoimmune bullous diseases including bullous pemphigoid, pemphigus, and dermatitis herpetiformis, DIF studies have a sensitivity of 80% to 90%. DIF negative cases of these disorders may be further tested by serum studies. The methods for collection of specimens are available under specimen collection


DIF studies for IgG, IgA, IgM, fibrin and C3 are offered for the following autoimmune diseases: 

  • Bullous diseases (pemphigus, pemphigoid, dermatitis herpetiformis)

  • Collagen vascular diseases (SLE, DLE, SCLE)

  • Vasculitis, livedo vasculitis

  • Lichen planus 

  • Differentiation of bullous pemphigoid (BP) from epidermolysis bullosa acquisita (EBA) with DIF of salt (NaCl) split biopsy. 


DIF studies are also offered for: 

  • Dermatomyositis (C5b-9 included)

  • Scleroderma (Complement plus DIF included)

  • Chronic ulcerative stomatitis

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