Immunofluorescence Services

DIF is useful in the diagnosis of suspected autoimmune disease, connective tissue diseases and vasculitis. The staining patterns seen in tissue samples may be specific to a disease or may need to be interpreted with the clinical and histological findings.

What is Immunofluorescence?

01. Direct immunofluorescence
where antigens of interest have been bound in vivo by immunoglobulins with sampling of the skin.

02. Indirect immunofluorescence
where blood is taken to determine circulating antibodies to antigens of interest.

Direct immunofluorescence for the diagnosis of skin diseases

Autoimmune Bullous Diseases

Pemphigus vulgaris
Pemphigus foliaceus
Paraneoplastic pemphigus
Immunoglobulin (Ig) A pemphigus
Bullous pemphigoid
Pemphigoid gestationis
Mucous membrane pemphigoid (cicatricial pemphigoid)
Epidermolysis bullosa acquisita
Bullous systemic lupus erythematosus (SLE)
Linear IgA bullous disease
Dermatitis herpetiformis

Vasculitis & Other Conditions

Small vessel (hypersensitivity) vasculitis
Henoch–Schönlein purpura
Lichen planus
Porphyria cutanea tarda
Some adverse cutaneous reactions to drugs
Photosensitivity rashes

Connective Tissue Diseases

Lupus erythematosus (systemic, discoid, and subacute cutaneous forms)
Neonatal lupus erythematosus
Systemic sclerosis
Mixed connective tissue disease
Dermatomyositis

Where is the optimal site for biopsy?

The optimal site for taking a biopsy of the skin depends on the suspected disease.

Autoimmune Disorders
An optimal biopsy is a 3 or 4 mm punch biopsy taken from the perilesional skin (normal looking skin next to the rash) or mucous membrane tissue taken with tissue in concert with normal looking tissue.

Bullous Blisters
It is imperative that the active part of the rash or blister is taken with unreactive tissue so that a comparative analysis of tissue can be performed.

Vasculitis and Connective Tissue Diseases
A biopsy should be taken from lesional skin because uninvolved lesions are usually negative and in vasculitis, the reaction is evident in the vessels.

Transport and storage of the biopsy sample

Specimens should be placed in Michel’s fixative for transport.

Michel’s fixative can be stored at room temperature for up to two months.

Place a punch biopsy (preferable a 3-4mm punch) directly into the Michel’s transport media.

Place the container into a plastic bag and place the primary container into the shipping box at ambient temperature.

Ship the speciment to KorPath as soon as possible.