China Journal of Leprosy and Skin Diseases ›› 2025, Vol. 41 ›› Issue (6): 395-399.doi: 10.12144/zgmfskin202506395

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Application of mosaic indirect immunofluorescence technique in the diagnosis of bullous pemphigoid

ZHOU Shengru1, CAI Yang2, WANG Jingying3, ZHANG Xuetong1, LI Min1, PAN Meng3   

  1. 1 Department of Dermatology, The Fourth Affiliated Hospital of Soochow University (Suzhou Dushu Lake Hospital), Suzhou 215000, China; 2 Center of Clinical Laboratory, The Fourth Affiliated Hospital of Soochow University (Suzhou Dushu Lake Hospital), Suzhou 215000, China; 3 Department of Dermatology, Ruiin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
  • Online:2025-06-15 Published:2025-05-21

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Abstract: Objective: To detect the sensitivity and specificity of the mosaic indirect immunofluorescence (IIF) with salt-split monkey skin and monkey esophagus as dual substrates in the diagnosis of bullous pemphigoid (BP), so as to evaluate its application value. Methods: Serum samples of 51 patients from June 2021 to April 2023, including 30 BP patients and 21 controls (5 eczema patients, 3 pemphigus patients, 2 linear IgA bullous dermatosis patients, 1 anti-p200 pemphigoid patient and 10 normal controls), were detected by Mosaic IIF detection and fluorescence deposition was observed. Results: When using salt-split monkey skin as substrate for IIF detection, 28 out of 30 BP serum samples were positive, with a sensitivity of 93.33%. And 27 cases were positive with IgG epidermal localization, 1 case showed deposits both in dermis and epidermis, and 2 cases were negative. Among the controls, the anti-p200 pemphigoid case showed linear IgG deposition binding to the dermal side, the eczema case showed IgG linear deposits on the epidermal side, and other controls were negative, with a specificity of 95.24%. When IIF was performed using monkey esophagus as the substrate, 22 BP cases showed IgG linear deposits at the basement membrane zone, with a sensitivity of 73.33%. In the control group, 3 pemphigus patients showed intercellular IgG deposits in the spinous layer, while no deposits was observed in other controls, with a specificity of 100%. There was no statistically significant difference in the sensitivity and specificity between IIF with salt-split monkey skin and monkey esophagus substrates for BP diagnosis (P＞0.05). Conclusion: Mosaic IIF demonstrates high sensitivity and strong specificity in the serological diagnosis of BP patients. The positive results of mosaic IIF with monkey esophagus and salt-split monkey skin substrates can corroborate each other in the diagnosis of BP. Moreover, monkey esophagus substrate can differentiate pemphigus, while salt-split monkey skin can differentiate anti-p200 pemphigoid.

Key words: salt-split skin, indirect immunofluorescence, monkey esophagus, bullous pemphigoid, autoimmune bullous diseases