Noninvasive visualization of intraepidermal and subepidermal blisters in vesiculobullous skin disorders by in vivo reflectance confocal microscopy

Excerpt

Bullous dermatoses are characterized by skin blistering resulting from local injury with breakdown of tissue integrity and fluid accumulation within specific layers of the skin. These disorders are traditionally classified into subcorneal, suprabasal, and subepidermal blistering by the specific location of the split in the epidermis [1, 2]. Of special interest is the group of autoimmune blistering diseases that comprise a wide spectrum of clinical presentations and are mediated by pathogenic antibodies targeting specific adhesion molecules responsible for cutaneous homeostasis and integrity [3]. Diagnosis is based on the clinical picture, histology, direct and indirect immunofluorescence, immunoblotting, immunoprecipitation and immunoelectron microscopy [4, 5]. Though crucial for accurate diagnosis and for selection of specific therapy, these techniques are cumbersome, time-consuming and unlikely to be widely available, leaving blister level determination by classical histology a key diagnostic procedure in intraepidermal and subepidermal blistering diseases. …