Medicine

Is it necessary to have skin bullae to diagnose pemphigoid?

- March 18, 2022 | April 22, 2022 - Kate

Relevance A new study shows that bullae are not necessary for a diagnosis of bullous

Is it necessary to have skin bullae to diagnose pemphigoid?

Blisters are not necessary for a diagnosis of bullous pemphigoid, a new study suggests.

As you know, some patients with this disease do not develop skin blisters, which means that the diagnosis is not always correctly established. The diagnostic criteria were revised in a Dutch study.

Study design

The analysis included 1125 patients with suspected pemphigoid (bullous and non-bullous form) who were observed in one of the medical centers in the Netherlands. Patients underwent skin biopsies followed by immunological and serological examination. The biopsy was performed before starting immunosuppressive therapy.

results

Of the 1125 patients, 58% were women, with a median age of 63 years.

  • Of all patients, the diagnosis of pemphigoid was confirmed in 343 patients, the remaining 782 patients formed the control group.
  • Of the 343 patients, 74 (21.6%, i.e. one in five) had a non-bullous form of the disease.
  • The most sensitive method for confirming the diagnosis was direct immunofluorescence microscopy (88.3% [n = 303]; 95% CI, 84.5%-91.3%), while indirect immunofluorescence on human salt-cleaved skin substrate had less sensitivity (77.0% [n = 263]; 95% CI, 72.2%-81.1%), but greater specificity (99.9%; 95% CI, 99.3%-100%).
  • The investigators proposed the following criteria for establishing pemphigoid: pruritus and/or skin blisters; linear IgG and/or C3c deposits detected by direct immunofluorescence microscopy in skin biopsies; positive staining of the epidermal layer of IgG using the method of indirect immunofluorescence.

Conclusion

Pemphigoid can be either bullous or non-bullous. Direct immunofluorescence microscopy and indirect immunofluorescence should be used to confirm the diagnosis.

Source: Joost M. Meijer, Gilles F. H. Diercks, Emma W. G. de Lang, et al. JAMA Dermatol. Published online January 9, 2019.

All-Russian Educational Internet Session

The information and materials presented on this site are of a scientific, reference and analytical nature, are intended exclusively for healthcare professionals, are not aimed at promoting products on the market and cannot be used as advice or recommendations to the patient on the use of medicines and treatment methods. without consulting your doctor.

Medicines, information about which is contained on this site, have contraindications, before using them, you must read the instructions and consult with a specialist.

The opinion of the Administration may not coincide with the opinion of the authors and lecturers.The administration does not give any guarantees regarding the site and its contents, including, without limitation, regarding the scientific value, relevance, accuracy, completeness, reliability of the scientific data presented by the lecturers or the compliance of the contents with international standards of good clinical practice and / or based medicine. on the evidence. The Site assumes no responsibility for any recommendations or opinions that may be contained, nor for the applicability of the materials on the Site to specific clinical situations. All scientific information is provided as is, with no guarantee of completeness or timeliness. The administration makes every effort to provide users with accurate and reliable information, but at the same time does not exclude the possibility of errors.