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The diagnosis of sub‐epithelial bullous diseases
Author(s) -
Carrozzo M
Publication year - 2006
Publication title -
oral diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.953
H-Index - 87
eISSN - 1601-0825
pISSN - 1354-523X
DOI - 10.1111/j.1601-0825.2006.01306_5.x
Subject(s) - iif , autoantibody , pathology , basement membrane , bullous pemphigoid , immunostaining , medicine , antigen , immunofluorescence , antibody , cicatricial pemphigoid , pemphigoid , human skin , biopsy , immunology , immunohistochemistry , biology , genetics
There are a number of sub‐epithelial vesiculobullous disorders that may produce similar clinical pictures in the oral cavity, with antibodies directed against various hemidesmosomal components or components of the epithelial basement membrane. The term immune‐mediated sub‐epithelial blistering diseases (IMSEBD) have therefore been used. The diagnosis of IMSEBD on clinical grounds alone is impossible and a full history, general, and oral examination, biopsy with immunostaining are now invariably required, sometimes supplemented with other special investigations. The main subepithelial blistering disease is mucous membrane pemphigoid (MMP) that includes a range of variants frequently having oral and especially gingival lesions. Exclusive oral MMP (OP) has been reported to have frequently a low frequency of positive indirect immunofluorescence (IIF) findings without serologic reactivity to recognised MMP antigens. However, the low frequency of detection of autoantibodies in the sera of OP patients may be due to insufficiently sensitive detection techniques. Indeed, most of the patients with OP have circulating auto‐antibodies (autoAb) against the epidermal side of the basement membrane zone (BMZ) with IIF using normal human salt‐split skin (SSS) as substrate. Combining very sensitive techniques as IIF‐SSS, immunoblotting (IB) on extracts of human keratinocyte cultures and ELISA systems up to 90% of the patients have circulating autoantibodies against the BMZ.