Marian Dmochowski
Poznan University of Medical Sciences, Poland
Title: Imaging and biochemical-molecular techniques for diagnosing autoimmune blistering dermatoses
Biography
Biography: Marian Dmochowski
Abstract
Autoimmune blistering dermatoses (ABDs) require precise diagnosis as generally aggressive therapies having potentially lethal side-effects are necessary. Nowadays, they can be reliably diagnosed using a combination approach with both imaging and biochemical-molecular techniques. Taking into account cost effectiveness, I am using an imaging technique with singlestep direct immunofluorescence (DIF) of perilesional tissue and DIF of plucked scalp hair which is appropriate for evaluation of IgA, IgG, IgM, C3 as well as IgG4 and IgG1 subclasses deposits. Dew drops on spider web appearance is newly named by me, diagnostically valuable and putatively having implications for treatment, pattern of Th2-dependent IgG4 deposition in
pemphigus diseases at an active-stage with DIF techniques. In addition to DIF, still the golden standard for diagnosing ABDs, serum studies using biochemical-molecular techniques, namely ELISA, are necessary. Currently, the author is using a multianalyte ELISA enabling the detection of IgG antibodies to desmoglein 1, desmoglein 3, BP180, BP230, envoplakin and type
VII collagen in a single procedure. In case of clinical suspicion of dermatitis herpetiformis an ELISA for serum IgA antibodies to tissue translglutaminase, instead of multi-analyte ELISA, is used in addition to DIF. Such a dual imaging/biochemicalmolecular approach is usually sufficient to detect autoimmune nature of a blistering dermatosis in question, enabling one to
resign from performing H+E histology and indirect immunofluorescence studies. Despite substantial progress in diagnosing ABDs heading toward all-in-one methodology, treatment schemes are still unsatisfactory. The aim of future therapeutic efforts should be based on a personalized medicine principle.