DIrect immunofluorescence ON plucked hair IN IMMUNOLOGICAL DISEASES of the skin Razvan Theodor Andrei*, Adina Alexandru**, Tiberiu Tebeica*, Sabina Zurac*, Florica Staniceanu*, Carmen Maria Salavastru**, Sorin George Tiplica** (Note: Andrei and Alexadru should be regarded as first authors in equal proportion) * Pathology Department, ** Dermatology Department, Colentina University Hospital, Bucharest Background: Direct immunofluorescence (DIF) is an indispensable diagnostic tool in immunological diseases and can also be used for monitoring the therapeutic response; some authors propose DIF on plucked hair in pemphigus vulgaris (PV) as an alternative for repetitive skin biopsies Material and Method: We studied 11 cases of immunological diseases: 6 cases of PV, 4 cases of lupus erythematosus (LE) and 1 case of bulous pemphigoid (BP) and we tried to evaluate the importance of DIF on plucked hair in diagnosis. For every patient we analyzed: one skin biopsy for paraffin, one skin biopsy for DIF and plucked hair from the scalp for DIF. Hematoxylin-eosin (HE) and DIF were performed on frozen section. In paraffin processing we used HE and special stains as Giemsa, PAS and Alcian Blue pH2,5.

DIF was used both in cutaneous biopsies and hair follicle. Material and Method (cont.): In DIF we evaluated the expression of IgA, IgM, IgG, C3, C1q and fibrinogen DIF was used both in cutaneous biopsies and hair follicle. In one patient with PV, plucked hair from the inguinal and axilar area were analyzed as well as Tzank smears In another patient with PV, telogen hair from “brush” was also analyzed. Results All but one patients were women. The BP patient was male. The mean age was 48.75 years (59.66 years in PV group). In PV group IgG and C3 were positive intercellular, in characteristic net-like pattern in both epidermis and outer sheath of hair follicle, with a weaker positivity for C3; in inguinal and axilar hair IgG and C3 were positive too while in telogen hair from “brush” were negative In LE and BP cases, DIF tests on plucked hair were negative

Pemphigus vulgaris - 73 years old female C3 plucked hair IgG skin biopsy IgG IgG C3 IgG plucked hair plucked hair C3

Bulous pemphigoid - 63 years old male IgG IgG Bulous pemphigoid - 63 years old male Lupus erythematosus - 48 years old female plucked hair IgM IgG C3

Conclusions DIF (for IgG and C3) in PV has similar results in both plucked hair and skin biopsy → DIF of plucked hair could replace skin biopsy in diagnosis of pemphigus vulgaris DIF on plucked hair was negative for IgG, IgM or C3 in LE and BP→ In lupus erythematosus and bulous pemphigoid, DIF of plucked hair has no diagnostic value