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Raha S, Desai RS, Bansal SP, Shirsat PM, Prasad P. Efficacy of anti-desmoglein 1 and anti-desmoglein 3 levels by enzyme-linked immunosorbent assay compared to biopsy of chronic oral ulcerative diseases with positive Nikolsky's sign to diagnose oral pemphigus vulgaris with or without skin involvement: a retrospective institutional observational pilot study. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:353-359. [PMID: 37507320 DOI: 10.1016/j.oooo.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/11/2023] [Accepted: 05/25/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVE We assessed the efficacy of anti-desmoglein 1 (anti-DSG1) and anti-DSG3 levels by enzyme-linked immunosorbent assay (ELISA) as a preliminary diagnostic test in the diagnosis of oral pemphigus vulgaris (OPV) with or without skin involvement compared to biopsy. STUDY DESIGN We retrospectively analyzed data collected from 23 patients (mean age 45.13 years) who had presented with chronic oral ulcerations, desquamative gingivitis, and a positive Nikolsky's sign. We performed ELISA, histopathologic examination, and direct immunofluorescence (DIF) and then calculated the sensitivity and specificity of the results of ELISA, histopathology, DIF, and the presence of a positive Nikolsky's sign in diagnosis. RESULTS The ELISA results showed that 18 patients had elevated anti-DSG3 levels, of whom 8 also had elevated anti-DSG1 levels. The histopathology results indicated that 18 patients had OPV, of whom 4 had oral lichen planus, and 1 had sub-epithelial blistering disease confirmed to be mucous membrane pemphigoid MMP by DIF. ELISA, histopathology, and DIF had a 100% sensitivity and specificity, and the presence of a positive Nikolsky's sign had a sensitivity and specificity of 100% and 78.26%, respectively. CONCLUSIONS Measurement of anti-DSG1 and anti-DSG3 levels by ELISA warrants consideration as a first-line diagnostic test for early detection of OPV with or without skin involvement over biopsy.
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Affiliation(s)
- Sampurna Raha
- Department of Oral Pathology and Microbiology, Nair Hospital Dental College, Mumbai, India
| | - Rajiv S Desai
- Department of Oral Pathology and Microbiology, Nair Hospital Dental College, Mumbai, India.
| | - Shivani P Bansal
- Department of Oral Pathology and Microbiology, Nair Hospital Dental College, Mumbai, India
| | - Pankaj M Shirsat
- Department of Oral Pathology and Microbiology, Nair Hospital Dental College, Mumbai, India
| | - Pooja Prasad
- Department of Oral Pathology and Microbiology, Nair Hospital Dental College, Mumbai, India
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Kumaresan M, Gurusamy U, Rai R, Srinivas CR. Plucked Hair as a Substrate for Indirect Immunofluorescence in Cases of Pemphigus Vulgaris. Int J Trichology 2020; 12:114-117. [PMID: 33223735 PMCID: PMC7659737 DOI: 10.4103/ijt.ijt_59_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction Indirect immunofluorescence (IIF) is used to determine the circulating autoantibodies in cases of Pemphigus. For IIF in Pemphigus several substrates had been used. This study was done to determine whether plucked hair can be utilized as a substrate for IIF in cases of Pemphigus. Aim & Objectives: To determine the efficacy of utilizing the plucked hair as a substrate for indirect immunofluorescence among patients with Pemphigus vulgaris. Methodology Thirty two consecutive patients with active and fresh diagnosed cases of pemphigus vulgaris (PV) who did not undergo any treatment and those patients who had positive DIF findings of characteristic fish net or chicken wire pattern of intercellular IgG deposits in the epidermis of perilesional skin were included in the study. A total of 32 control subjects without any auto immune disorders were selected and the blood samples were taken from these patients for IIF analysis. Anagen hair were collected from the healthy volunteers without pemphigus in the same way as for trichogram. Telogen hair were obtained by combing the hair and collecting the loose strands of hair on the comb and further confirmed under microscope. Three hairs each of anagen and telogen stage were collected from each subject to be utilized as a substrate for IIF. Results Out of 32 samples 20 samples showed positive results for Ig G alone and 5 samples showed positivity for Ig G and C3. One sample showed positivity for C3alone. All these 26 samples were considered to have positive IIF test based on the intercellular pattern of deposit. Positive IIF results were observed in anagen hair samples and were negative in all the telogen hair samples. Six anagen hair samples did not show any positive findings in IIF for the study group. All the 32 control samples showed negative reports in IIF. Conclusion In conclusion, IIF microscopy on plucked hair as a substrate is a more sensitive immunoassay for the detection of circulating intercellular autoantibodies in PV and the lower negative predictive value of this substrate is a limitation. Further large scale studies might provide better information regarding the practical utility.
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Affiliation(s)
- Muthuvel Kumaresan
- Cutis Skin Clinic and Hair Transplant Center, Coimbatore, Tamil Nadu, India
| | | | - Reena Rai
- Department of Dermatology, PSGIMSR, Coimbatore, Tamil Nadu, India
| | - C R Srinivas
- Rangas Skin Clinic, Coimbatore, Tamil Nadu, India
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The Significance of Scalp Involvement in Pemphigus: A Literature Review. BIOMED RESEARCH INTERNATIONAL 2018; 2018:6154397. [PMID: 29770335 PMCID: PMC5889856 DOI: 10.1155/2018/6154397] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 02/18/2018] [Indexed: 12/11/2022]
Abstract
Scalp is a unique location for pemphigus because of the abundance of desmogleins localized in hair follicles. Scalp involvement is observed in up to 60% of patients in the course of pemphigus. The lesions may occasionally lead to alopecia. Unforced removal of anagen hairs in a pull test is a sign of high disease activity. Direct immunofluorescence of plucked hair bulbs is considered a reliable diagnostic method in patients with pemphigus. Follicular acantholysis is a characteristic histopathological feature of pemphigus lesions localized on the scalp. Trichoscopy may serve as a supplementary method in the diagnosis of pemphigus. This review summarizes the most recent data concerning scalp involvement in pemphigus vulgaris and pemphigus foliaceus. A systematic literature search was conducted in three medical databases: PubMed, Embase, and Web of Science. The analysis included literature data about desmoglein distribution in hair follicles, as well as information about clinical manifestations, histopathology, immunopathology, and trichoscopy of scalp lesions in pemphigus and their response to treatment.
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Rai R, Harikumar MV. Comparison of Direct Immunofluorescence of Plucked Hair and Skin for Evaluation of Immunological Remission in Pemphigus. Indian Dermatol Online J 2017; 8:319-322. [PMID: 28979862 PMCID: PMC5621189 DOI: 10.4103/idoj.idoj_280_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Pemphigus is a chronic autoimmune bullous disorder characterized by autoantibodies directed against desmoglein 3 and/or 1. Demonstration of intercellular deposition of IgG on the cell surface of keratinocytes by direct immunofluorescence (DIF) of the skin is the gold standard in the diagnosis of pemphigus. Recently, DIF of plucked hair demonstrating intercellular deposition of IgG in the outer root sheath (ORS) has shown to be useful. OBJECTIVE To compare the DIF of plucked hair and skin for the evaluation of immunological remission in pemphigus vulgaris patients in clinical remission. MATERIALS AND METHODS A total of 30 patients with pemphigus vulgaris with positive DIF of the skin and hair at baseline were included, and DIF of skin and hair was repeated after 6 months or more of clinical remission (with no new/non-healing lesions). Presence of intercellular deposits of IgG and or C3 in skin and ORS of the hair was considered as positive. RESULTS Of the 30 patients, DIF of skin was positive in 10 patients and hair was positive 14 patients. The findings of hair and skin DIF correlated with each other in 22 patients. In 6 (20%) patients DIF of hair was positive even though the DIF of skin was negative. The sensitivity of hair DIF was 80% and specificity was 70%. LIMITATIONS Small sample size. CONCLUSION DIF of hair is a simple, non-invasive, and cost effective procedure and can be used as an additional procedure for the assessment of immunological remission in patients with pemphigus vulgaris.
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Affiliation(s)
- Reena Rai
- Department of Dermatology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Manu V. Harikumar
- Department of Dermatology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
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Sar-Pomian M, Czuwara J, Rudnicka L, Olszewska M. Miniaturization of sebaceous glands: A novel histopathological finding in pemphigus vulgaris and pemphigus foliaceus of the scalp. J Cutan Pathol 2017. [DOI: 10.1111/cup.12994] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Marta Sar-Pomian
- Department of Dermatology; Medical University of Warsaw; Warsaw Poland
| | - Joanna Czuwara
- Department of Dermatology; Medical University of Warsaw; Warsaw Poland
| | - Lidia Rudnicka
- Department of Dermatology; Medical University of Warsaw; Warsaw Poland
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Abstract
Immunofluorescence (IF) tests have redefined our understanding of many immune-mediated skin diseases, especially autoimmune blistering diseases (AIBDs). Nomenclature of certain AIBDs (for example, linear IgA diseases and IgA pemphigus) has been done based solely on the finding of tissue-bound immunoreactants as detected by IF tests. Direct and indirect are the two major types of IF tests; they are not only useful in the diagnosis but also guide the clinician in the treatment at least in certain AIBDs, as the titer of circulating antibodies as detected by IF reflects the disease activity. In this review, we describe techniques, various types of IF, and its modification.
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Affiliation(s)
- Varsha M Shetty
- Department of Dermatology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Kumudhini Subramaniam
- Department of Dermatology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Raghavendra Rao
- Department of Dermatology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
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Assessment of the role of direct immunofluorescence of the outer root sheath in the diagnosis of pemphigus patients. JOURNAL OF THE EGYPTIAN WOMEN’S DERMATOLOGIC SOCIETY 2016. [DOI: 10.1097/01.ewx.0000483141.15448.e4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ghanadan A, Saghazadeh A, Daneshpazhooh M, Rezaei N. Direct immunofluorescence for immunobullous and other skin diseases. Expert Rev Clin Immunol 2015; 11:589-96. [DOI: 10.1586/1744666x.2015.1025059] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Plucked human hair shafts and biomolecular medical research. ScientificWorldJournal 2013; 2013:620531. [PMID: 24302865 PMCID: PMC3835906 DOI: 10.1155/2013/620531] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 09/24/2013] [Indexed: 11/17/2022] Open
Abstract
The hair follicle is a skin integument at the boundary between an organism and its immediate environment. The biological role of the human hair follicle has lost some of its ancestral importance. However, an indepth investigation of this miniorgan reveals hidden complexity with huge research potential. An essential consideration when dealing with human research is the awareness of potential harm and thus the absolute need not to harm—a rule aptly qualified by the Latin term “primum non nocere” (first do no harm). The plucked hair shaft offers such advantages. The use of stem cells found in hair follicles cells is gaining momentum in the field of regenerative medicine. Furthermore, current diagnostic and clinical applications of plucked hair follicles include their use as autologous and/or three-dimensional epidermal equivalents, together with their utilization as surrogate tissue in pharmacokinetic and pharmacodynamics studies. Consequently, the use of noninvasive diagnostic procedures on hair follicle shafts, posing as a surrogate molecular model for internal organs in the individual patient for a spectrum of human disease conditions, can possibly become a reality in the near future.
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Rao R, Dasari K, Shenoi SD, Balachandran C, Dinesh P. Monitoring the disease activity in pemphigus by direct immunofluorescence of plucked hair: a pilot study. Indian J Dermatol 2013; 58:164. [PMID: 23716856 PMCID: PMC3657266 DOI: 10.4103/0019-5154.108111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Raghavendra Rao
- Frrom the Department of Skin and VD, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
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Tanasilovic S, Medenica L, Popadic S. Direct immunofluorescence of the outer root sheath in anagen and telogen hair in pemphigus vulgaris and pemphigus foliaceus. Australas J Dermatol 2013; 55:e74-6. [PMID: 23713982 DOI: 10.1111/ajd.12067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 03/29/2013] [Indexed: 11/29/2022]
Abstract
Direct immunofluorescence of peri-lesional skin is the gold standard in the diagnosis of pemphigus. A specific immunofluorescence pattern may also be demonstrated in the outer root sheath of anagen and telogen hair. We demonstrated an intercellular reticular deposition of immunoglobulin G in the outer root sheath of plucked anagen and telogen hair in all pemphigus vulgaris patients with active disease and for the first time in all patients with active pemphigus foliaceus. Moreover, we demonstrated for the first time that plucked hair samples may be kept at -20°C for at least 2 weeks before immunofluorescent staining and analysis.
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Affiliation(s)
- Srdjan Tanasilovic
- Department of Dermatovenereology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic of Dermatovenereology, Clinical Center of Serbia, Belgrade, Serbia
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Daneshpazhooh M, Naraghi ZS, Ramezani A, Ghanadan A, Esmaili N, Chams-Davatchi C. Direct immunofluorescence of plucked hair for evaluation of immunologic remission in pemphigus vulgaris. J Am Acad Dermatol 2011; 65:e173-7. [DOI: 10.1016/j.jaad.2010.09.721] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 09/01/2010] [Accepted: 09/12/2010] [Indexed: 11/25/2022]
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Kumaresan M, Rai R, Sandhya V. Immunofluorescence of the outer root sheath: an aid to diagnosis in pemphigus. Clin Exp Dermatol 2010; 36:298-301. [PMID: 21198796 DOI: 10.1111/j.1365-2230.2010.03981.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The direct immunofluorescence (DIF) pattern of the outer root sheath (ORS) of the hair follicle in patients with pemphigus resembles that of perilesional skin. We performed DIF on anagen and telogen hair ORS from patients with pemphigus and compared the findings with those of perilesional skin. AIM To assess the sensitivity of DIF in the ORS of anagen and telogen hair in patients with pemphigus with positive DIF results in perilesional skin. METHODS In total, 50 patients with active pemphigus and positive DIF findings in perilesional skin were selected for the study. Anagen hair was obtained from the scalp by the same method used for a trichogram, and telogen hair was selected by combing the hair and collecting the loose strands of hair from the comb. The hair type was further confirmed by microscopy. Hair samples were transported in Michel medium and prepared for DIF by mounting on a slide without sectioning. Anagen and telogen hair samples were also collected from 50 controls. RESULTS Immunological deposits characteristic of pemphigus were found in the ORS of anagen and telogen hairs in all 50 patients, but in none of the 50 controls. Positive DIF findings were seen in scalp hair irrespective of the presence of scalp lesions. Of the 50 patients with pemphigus, 46 were diagnosed with pemphigus vulgaris, 2 with pemphigus vegetans, and 1 each with pemphigus foliaceus and pemphigus erythematosus, based on the clinical, histopathological and DIF findings. All the pemphigus variants had positive DIF findings in the ORS. CONCLUSIONS Using DIF on telogen hair ORS promises to be a useful tool for diagnosis and follow-up in cases of pemphigus.
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Affiliation(s)
- M Kumaresan
- Department of Dermatology, PSG Institute of Medical Sciences and Research, Peelamedu, Coimbatore, India.
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Kumaresan M, Rai R, Sandhya V. Immunofluoresence of the outer root sheath in anagen and telogen hair: an aid to diagnosis in pemphigus. Int J Trichology 2009; 1:138-9. [PMID: 20927237 PMCID: PMC2938577 DOI: 10.4103/0974-7753.58558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Desmoglein 1 and 3 are distributed in the outer root sheath (ORS) of the hair follicle. Direct immunofluoresence (DIF) pattern of ORS in cases of pemphigus resembles the DIF pattern of the perilesional skin. We performed a DIF of the anagen and telogen hair ORS in a case of pemphigus and correlated it with the DIF findings of perilesional skin. Telogen hair ORS promises to be a useful tool in performing DIF for the purpose of diagnosis and follow-up in cases of pemphigus
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Affiliation(s)
- M Kumaresan
- Department of Dermatology, PSG Hospitals, Coimbatore, India
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