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Background <p>Bullous pemphigoid (BP) is the most common type of subepidermal bullous disease. The detection of linear deposition of immunoglobulin G (IgG) and/or C3 at the dermo-epidermal junction using direct immunofluorescence (DIF) is the gold standard for diagnosis; however, it requires a fresh tissue specimen. Since the immunohistochemistry (IHC) of complement component C4d is easy and more accessible, this technique can also serve as an efficient method. Our objective is to compare the IHC results for C4d with the DIF results in cases suspected of BP.</p> Methods <p>Seventeen cases of bullous skin lesions and the dermatitis mimicking bullous diseases were evaluated through DIF and IHC. Clinical and demographic data were obtained from the laboratory database.</p> Results <p>Out of 17 cases, seven were diagnosed with BP, while the other seven cases were diagnosed with other bullous diseases or dermatitis mimicking bullous diseases, including pharmacodermia (<i>n</i> = 4), contact dermatitis (<i>n</i> = 1), dermatitis herpetiformis (<i>n</i> = 3) and non-specific bullous disease (<i>n</i> = 2). In the DIF analysis, IgG and C3 were positive in 57.1% of the BP cases, while all other diseases were negative. C4d immunoexpression was positive in 85.7% of the BP, whereas it was negative in almost all other cases.</p> Conclusion <p>The C4d IHC study is a valuable diagnostic tool for BP and is especially helpful in cases where clinical suspicion and histology strongly suggest BP, but the frozen samples are negative for DIF.</p>

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Bullous pemphigoid: analysis of C4d by immunohistochemistry in suspected cases

  • 期刊论文

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  • 发表日期：

    2025年3月10日

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  • Larissa D.’Epiro de Souza Campos,
  • Jussara Maria Gonçalves,
  • Hercílio Fronza Junior,
  • Hortência Gomes da Silveira,
  • Jaqueline Stall,
  • Rodrigo Blasius,
  • Bruna Louise Silva,
  • Paulo Henrique Condeixa de França,
  • Karina Munhoz de Paula Alves Coelho

摘要

Background

Bullous pemphigoid (BP) is the most common type of subepidermal bullous disease. The detection of linear deposition of immunoglobulin G (IgG) and/or C3 at the dermo-epidermal junction using direct immunofluorescence (DIF) is the gold standard for diagnosis; however, it requires a fresh tissue specimen. Since the immunohistochemistry (IHC) of complement component C4d is easy and more accessible, this technique can also serve as an efficient method. Our objective is to compare the IHC results for C4d with the DIF results in cases suspected of BP.

Methods

Seventeen cases of bullous skin lesions and the dermatitis mimicking bullous diseases were evaluated through DIF and IHC. Clinical and demographic data were obtained from the laboratory database.

Results

Out of 17 cases, seven were diagnosed with BP, while the other seven cases were diagnosed with other bullous diseases or dermatitis mimicking bullous diseases, including pharmacodermia (n = 4), contact dermatitis (n = 1), dermatitis herpetiformis (n = 3) and non-specific bullous disease (n = 2). In the DIF analysis, IgG and C3 were positive in 57.1% of the BP cases, while all other diseases were negative. C4d immunoexpression was positive in 85.7% of the BP, whereas it was negative in almost all other cases.

Conclusion

The C4d IHC study is a valuable diagnostic tool for BP and is especially helpful in cases where clinical suspicion and histology strongly suggest BP, but the frozen samples are negative for DIF.