investigations

Last reviewed 05/2021

• a skin or mucosal biopsy should be obtained for histology and direct immunofluorescence
  • direct immunofluorescence of perilesional skin shows intra-epidermal deposition of IgG between cells throughout the epidermis (1)
    
    
• indirect immunoflourescence of serum is frequently positive, but is less sensitive than direct immunofluorescence. It is useful in instances where a biopsy is difficult to obtain e.g. - in children, uncooperative adults (1)
  
  
• ELISA - to detect anti-desmoglein 1 and anti-desmoglein 3 IgG autoantibodies (2)

Reference:

• 1. Harman K.E et al. Guidelines for the management of pemphigus vulgaris. BJD 2003; 149: 926-937
• 2. Stanley J.R, Amagai M. Pemphigus, Bullous Impetigo, and the Staphylococcal Scalded-Skin Syndrome. NEJM 2006; 355:1800-1810