[In-vivo Confocal Microscopy for the Diagnosis of Mucous Membrane Pemphigoid]

An early diagnosis is crucial for the outcome of mucous membrane pemphigoid (MMP). The sensitivity of the so-called diagnostic gold standard, direct and indirect immune fluorescence (DIF/IIF) ranges from 30 to 80 %, and is thus lower than desirable. Moreover, conjunctival biopsy, mandatory in most cases, entails the risks of exacerbation. The purpose of this study is to establish the contribution of non-invasive in vivo confocal microscopy to the recognition of MMP.

We examined the conjunctiva of ten patients and ten control subjects with the confocal microscope Heidelberg Retina Tomograph II/Rostock Cornea Module and checked for differences in qualitative and quantitative structure of the connective tissue.

Pemphigoid patients showed an increase and/or aggregation of reticular connective tissue with hyperreflective strands in the substantia propria, as well as an increased subepithelial fibrosis compared to controls. The basal membrane zone was thicker and more hyperreflective than in the healthy subjects.

In-vivo confocal microscopy may serve as a useful additional diagnostic method in the detection of MMP.