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Cutaneous lupus erythematosus: direct immunofluorescence and epidermal basal membrane study
S A Sugai1, A B Gerbase, S S Cernea
1Division of Dermatology, Hospital das Clínicas, São Paulo, Brazil.
Insights
Histopathologic examination of cutaneous lupus erythematosus (CLE) lesions revealed that basement membrane thickening is consistently present. Direct immunofluorescence showed immunoglobulin deposits in most cases, correlating with basement membrane changes.
Area of Science:
- Dermatopathology
- Immunofluorescence
- Lupus Erythematosus
Background:
- Cutaneous lupus erythematosus (CLE) presents with characteristic discoid lesions.
- Histopathologic evaluation is crucial for diagnosing CLE.
- Basement membrane zone (BMZ) abnormalities are observed in CLE.
Purpose of the Study:
- To investigate the diagnostic utility of direct immunofluorescence (DIF) and periodic acid-Schiff (PAS) staining in CLE discoid lesions.
- To correlate DIF findings with BMZ thickening in CLE.
- To assess the relationship between immunoglobulin deposits and basement membrane changes.
Main Methods:
- Biopsy specimens from 71 patients with CLE discoid lesions were analyzed.
- Direct immunofluorescence (DIF) was used to detect immunoglobulin and complement deposits in the BMZ.
- Periodic acid-Schiff (PAS) staining was employed to evaluate basement membrane (BM) thickening in 31 matched specimens.
Main Results:
- DIF was positive in 66.20% of CLE cases.
- PAS staining revealed basement membrane thickening in 100% of examined specimens.
- An accordance between PAS-stained BM thickening and immunoglobulin deposits was observed in 70.97% of cases, irrespective of immunocomplex presence.
Conclusions:
- Basement membrane thickening is a consistent histopathologic finding in CLE discoid lesions.
- DIF positivity for immunoglobulin deposits often correlates with BM thickening.
- These histopathologic findings are important for the diagnosis of CLE discoid lesions.
Abstract:
Biopsy specimens of cutaneous discoid lesions of 71 patients with cutaneous lupus erythematosus (CLE) were studied. The material was examined by direct immunofluorescence (DIF) to establish positivity and morphologic patterns of immunoglobulins and complement deposits in the basement membrane zone (BMZ). A correlation between DIF results and thickening of the epidermis basement membrane (BM) stained by periodic acid-Schiff (PAS), obtained from 31 matched biopsy specimens, also is presented. Direct immunofluorescence had positive results in 66.20% of the 71 examinations and 70.97% of the matched examinations, whereas PAS showed BM thickening in 100% of the specimens. This observation stresses the importance of such histopathologic findings in the diagnosis of discoid lesions in CLE. There was no correlation between DIF patterns and PAS-stained BMZ thickening. These findings merit additional study. In conclusion, an accordance between PAS-stained BM thickening and immunoglobulin deposits has occurred in 70.97% of cases. This phenomenon does not depend on the presence of immunocomplexes, for it occurs even in cases in which immunocomplex deposits were not detected.