Direct Immunofluorescence Of Antibodies In The Follicles Of Plucked Hair And Their Correlation With Disease Severity In Pemphigus

Direct Immunofluorescence of Antibodies in the Follicles of Plucked Hair and Their Correlation with Disease Severity in PemphigusObjectivePemphigus is an autoimmune disease in which skin and mucous membrane often get involved. It is clinically characterized by intraepidermal vesicles or bullae that are easy to break and positive Nikolsky's sign. Pemphigus antibodies IgGs can be detected in the patients'serum by indirect immunofluorescence. Corticosteroids are the main therapy for the treatment of pemphigus at present, but they have a lot of side-effects if they have been used for a prolonged period. Direct immunofluorescence(DIF) in skin has very important significance to the diagnosis of pemphigus and the treatment of patients. However, we can't check patients by biopsy repeatedly. Therefore, the purpose of the study is on DIF of follicles of plucked hair and their correlation with disease severity in Pemphigus.Materials and Methods1. Materials1.1 Hairs of pemphigus patients: 50 patients from No.1 Hospital of China Medical University are definitely diagnosed by clinical features and immunofluorescence, and will be followed-up periodically. 20 hairs were plucked from each patient with pemphigus every time.1.2 15 healthy persons were selected as controls.1.3 Major reagent: FITC-binding sheep-anti-human IgG, C₃ antibody (American SIGMA Corporation) 2. MethodsHairs with follicles were stained by direct immunofluorescence.3. Results assessments3.1 IN judging the fluorescence findings, the following scale of intensity was used: negative (-), indecisive (+), faint (+), distinct(++) and strong(+++). 3.2 Disease severity was graded on a 0-10 scale based on the sum of the extent of the disease and the intensity of therapy required to control it. Disease severity was classified as mild, moderate, or severe based on a severity score of≤2, 3 to 6, or≥7, respectively.Results1. Intensity of DIF in the follicles showed positive correlated with the disease severity(r=0.505, P＜0.05).2. During a follow-up period of 4 to 20 months in 18 patients, 17 patients had positive IgG deposit at the first time. With disease improved, the intensity of DIF in 11 patients became weaken. 5 of 11 patients became negative. 7 of 17 patients relapsed; their intensity of DIF became strong. One patient had negative IgG deposit at the first time. When the patients relapsed at the follow-up period, the intensity of DIF became positive. 1 patient had distinct C3 deposit at the first time, with disease improved, it became negative.ConclusionIntensity of DIF in the follicles showed positive correlated with the disease severity. The repeated examination of DIF in the follicles of plucked hair from patients with pemphigus may be a utility method for guiding clinical therapy.