Norm of Cutaneous Immunofluorescence Biopsy
A descriptive, interpretive report of histologic study findings is made.
Usage of Cutaneous Immunofluorescence Biopsy
Bulbous pemphigoid, chilblain lesions, dermatitis herpetiformis, herpes gestationis, necrolytic migratory erythema, pemphigus, and porphyria cutanea tarda in scleroderma; indicated in the investigation of cutaneous forms of chronic discoid lupus erythematosus, blistering disease, and vasculitis; also used to confirm the histopathologic characteristics of skin lesions and to follow the results of treatment.
Description of Cutaneous Immunofluorescence Biopsy
A biopsy specimen of the skin is taken for direct epidermal immunofluorescent study. Direct immunofluorescence is a histologic technique whereby the skin sample is treated with fluorescein-conjugated human immunoglobulin antisera and then incubated and examined under ultraviolet radiation. Deposition of human immunoglobulins and complement components in skin tissue and lesions (indicating a disorder) is identified and differentiated by the immunofluorescent patterns demonstrated.
Professional Considerations of Cutaneous Immunofluorescence Biopsy
Consent form IS required.
May be contraindicated in bleeding disorders, anticoagulated states, and immunocompromised states.
- Obtain punch forceps, an antiseptic solution, gauze, and a sterile specimen container.
- A 4-mm punch biopsy or surgically excised specimen of involved or uninvolved skin is obtained.
- The specimen is quick-frozen in liquid nitrogen and stored at -94 degrees F (-70 degrees C). If the specimen is to be shipped to an outside lab, it is preserved in Michel holding solution with the pH maintained between 7.0 and 7.4.
- Just before beginning the procedure, take a “time out” to verify the correct client, procedure, and site.
- Apply a dry, sterile dressing to the biopsy site.
Client and Family Teaching
- The test typically is transiently painful.
- Place pressure over the site for 5 minutes if bleeding occurs.
- Results may not be available for several days.
Factors That Affect Results
- Amount of biopsy <4 mm is insufficient.
- The reliability of the immunofluorescence technique is affected by factors such as age and site of the lesion, type of immunofluorescence, and type of immuno-globulin. For this reason, histopathologic characteristics should also be used to confirm the results.
- The final report may take up to 3 days.