Ines Lakoš Jukić

Significance of immunofluorescence in the diagnosis of autoimmune bullous dermatoses

Direct immunofluorescence study remains the diagnostic gold standard in the assessment of patients with bullous disorders, despite novel immunoserologic tests such as enzyme-linked immunosorbent assay and immunoblotting. This contribution provides an update of the classification of autoimmune bullous diseases and diagnostic procedures, with an emphasis on immunofluorescence findings.

Autoimmune Blistering Diseases: Incidence and Treatment in Croatia

Dermatovenereology in Croatia has a long tradition, with the first Department of Dermatovenereology having opened in Zagreb in 1894. The diagnosis of autoimmune bullous disease is based on clinical, histopathologic, and immunopathologic findings. Future goals are to participate in multicenter studies because this is the only possibility for further investigation for these rare diseases.

Inflammatory epidermolysis bullosa acquisita in a 4-year-old girl.

This study presents a case of linear immunoglobulin A dermatosis‐like epidermolysis bullosa acquisita in a 4‐year‐old girl showing rapid, widespread and inflammatory skin lesions. The diagnosis was confirmed by histopathology, direct and indirect immunofluorescence, various immunoblotting analyses and enzyme‐linked immunosorbent assays. Despite the severe clinical manifestations, the disease was successfully controlled by combination therapy of oral prednisolone and dapsone.

Clinical and Immunological Study of 30 Cases With Both IgG and IgA Anti-Keratinocyte Cell Surface Autoantibodies Toward the Definition of Intercellular IgG/IgA Dermatosis

Several sporadic cases, in which direct and indirect immunofluorescence studies simultaneously detected IgG and IgA autoantibodies to keratinocyte cell surfaces, have been reported mainly under the name of IgG/IgA pemphigus. However, there have been no systematic studies for this condition. In this study, we collected 30 cases of this condition from our cohort of more than 5,000 autoimmune bullous disease cases, which were consulted for our diagnostic methods from other institutes, and summarized their clinical and immunological findings. Clinically, there was no male–female prevalence, mean age of disease onset was 55.6 years, and mean duration before this condition was suspected was 18 months. The patients showed clinically bullous and pustular skin lesions preferentially on the trunk and extremities, and histopathologically intraepidermal pustules and blisters with infiltration of neutrophils and eosinophils. Immunologically, ELISAs frequently detected IgG and IgA autoantibodies to both desmogleins and desmocollins. From the characteristic clinical, histopathological, and immunological features, which are considerably different from those in classical IgG types of pemphigus, we propose this disease as a new disease entity with preferential name of intercellular IgG/IgA dermatosis (IGAD). This was the largest study of IGAD to date.