Significance of vascular fluorescence of superficial and mid-dermis
Morel, P.; Crickx, B.; Civatte, J.
Annales de Dermatologie et de Venereologie 107(6): 507-513
1980
ISSN/ISBN: 0151-9638 PMID: 6999957 Document Number: 166124
Patients (479) were investigated under direct immunofluorescence with anti-IgA, anti-IgG, anti-IgM and anti-C3 [3rd component of complement] sera. Fluorescence of the vessels was demonstrated in the superficial and mid-dermis in 20.2% of cases. Three types of vascular fluorescence: homogeneous porphyria-like pattern (18%), granular (76%) and perivascular (6%), were seen. A porphyria-like type was seen exclusively in exposed healthy skin with the anti-IgG serum. There is a band-like deposit of IgG along the dermo-epidermal junction. This pattern was mostly found in lupus erythematosus [LE]. The granular type is discussed according to the class of the deposited Ig (IgG 6%; IgA 31%; IgM 48%; C3 71%) and according to etiology. Granular fluorescence was found in 96% of the necrotizing vasculitis with purpura (26/27). The IgA deposit, although non-specific, appears preferably associated with Schoenlein-Henoch purpura in adults. In 4 cases of IgA vasculitis where a renal biopsy function was performed, the pattern was that of IgA nephropathy. A granular fluorescence of the vessels is constantly found in mixed cryoglobulinemias (7/7) with or without purpura and in 8% of discoid (3/38) and in 31% of the systemic LE (10/32). This finding is exceptional in other collagen diseases: localized or systemic scleroderma (0/20), mixed connective tissue disease (1/9), dermatomyositis (0/6). A granular vascular C3 deposit was found in 6 of 24 patients with rheumatoid arthritis: all had antinuclear antibodies. Vascular fluorescence was exceptionally positive in bullous disease: bullous pemphigoid (1/24); dermatitis herpetiformis (0/14); pemphigus (2/22). It was positive in toxicoderma (4/13), liver diseases (primary biliary cirrhosis), in a few cases of prurigo, of idiopathic thrombopenic purpura and of Osler's bacterial endocarditis. A vascular fluorescence in the superficial and mid-dermis with the direct immunofluorescence technique may be useful for evaluating diagnosis and pathogenesis. Vascular fluorescence is rare in diseases where immune complexes are not involved in pathogenesis.