fibrin and Pemphigus

Diagnosis of bullous pemphigoid (BP) and pemphigus is based on clinical features, histology, immunofluorescence and laboratory data.. To evaluate features of BP and pemphigus at reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) in order to provide a rapid non-invasive bed-side diagnosis. Secondary objective was to evaluate the detectability of clinically non-visible lesions.. This was an observational, retrospective, multicentre study in which patients with suspicious lesions for BP or pemphigus underwent clinical assessment, RCM, OCT, blood tests and skin biopsy for histological and direct immunofluorescence examinations from January 2014 to December 2015. A total of 72 lesions in 24 selected patients were evaluated. Additionally, apparently unaffected skin at two different distances [near (1-2 cm) and far (2-3 cm)] from each lesion was examined to test subclinical lesion detectability.. RCM was able to detect subepidermal and intra-epidermal blisters, respectively, in 75% and 50% of the patients affected by BP and pemphigus. At OCT, the exact blister level was identified in all patients. Acantholytic cells were observed only at RCM in pemphigus (62.5%). Fibrin deposition inside the blisters was only found in BP, evidenced both at RCM and OCT. Among patients with BP, subclinical blisters were detected in nine (9.4%) clinically healthy skin, while among patients with pemphigus were observed in 10 (20.8%) apparently unaffected skin.. RCM and/or OCT provide useful information for a rapid diagnosis of BP and pemphigus and for the identification of biopsy site. Combined use of RCM and OCT is optimal because associates the higher resolution of RCM with the greater penetration depth of OCT. OCT could be an optimal tool for treatment monitoring, especially in the cases of subclinical lesions. However, histopathologic and immunologic examinations remain the gold standard for establishing the final diagnosis.

Topics: Adult; Aged; Aged, 80 and over; Asymptomatic Diseases; Fibrin; Humans; Microscopy, Confocal; Middle Aged; Pemphigoid, Bullous; Pemphigus; Point-of-Care Systems; Retrospective Studies; Skin; Tomography, Optical Coherence

Glycocalyx collapses during dehydration to produce electron-dense accretions. Confocal laser scanning microscopy (CLSM) may be used to visualize fully hydrated microbial biofilms.. Using CLSM, to analyse glycocalyx production by Staphylococcus aureus cells in skin lesions of bullous impetigo, atopic dermatitis and pemphigus foliaceus. A second objective was to compare numbers of S. aureus cells in tissue sections prepared by different methods for routine light microscopy.. S. aureus cells in skin lesions of impetigo, atopic dermatitis and pemphigus were stained with safranin, and positive staining with fluorescein isothiocyanate-conjugated concanavalin A was considered to indicate the presence of glycocalyx.. All S. aureus cells tested in skin lesions of impetigo, atopic dermatitis and pemphigus were covered with glycocalyx and formed microcolonies. The numbers of S. aureus cells in a routine light microscopy section were significantly lower than those in a frozen section that had not been dehydrated with ethanol.. S. aureus cells generally produce glycocalyx in skin lesions of bullous impetigo, atopic dermatitis and pemphigus foliaceus, which accounts for the difficulty of removing S. aureus cells from these skin lesions. The glycocalyx may collapse during dehydration and most of the S. aureus cells may be carried away during preparation of routine light microscope sections.

Topics: Acetic Acid; Adolescent; Adult; Aged; Biofilms; Child; Child, Preschool; Colony Count, Microbial; Dermatitis, Atopic; Female; Fibrin; Fusidic Acid; Glycocalyx; Humans; Hydrochloric Acid; Impetigo; Male; Microscopy, Confocal; Middle Aged; Pemphigus; Staphylococcus aureus

Topics: Aged; Biopsy; Diagnosis, Differential; Erythema Multiforme; Female; Fibrin; Fibrinogen; Humans; Leukoplakia; Lichen Planus; Male; Microscopy, Fluorescence; Microtomy; Mouth Diseases; Mouth Mucosa; Pemphigus; Staining and Labeling

Topics: Blister; Dapsone; Dermatitis Herpetiformis; Diagnosis, Differential; Erythema Multiforme; Fibrin; Fluorescent Antibody Technique; Humans; Pemphigus; Skin; Staining and Labeling