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Immunobullous Skin Diseases Testing Click here for topics associated with this algorithm

INDICATIONS FOR TESTING


Symptomatic adults

Screen for Immunobullous Diseases (pemphigus, pemphigoid, epidermolysis Pregnant female, typically 2nd trimester
Presence of neoplastic disease
bullosa acquisita, linear IgA disease, or dermatitis herpetiformis)
Perilesional skin biopsy Perilesional skin biopsy for Cutaneous Direct Perilesional skin biopsy for Cutaneous Direct
Cutaneous Direct Immunofluorescence, Biopsy 0092572 Immunofluorescence, Biopsy 0092572 Immunofluorescence, Biopsy 0092572
Serum tests AND AND
Pemphigus Panel 0090650, Pemphigoid Panel 0092001, and Endomysial Paraneoplastic Pemphigus Antibody Screen 0092107 Herpes Gestationis Factor 0092283
Antibodies 0050734 (all 3 tests recommended unless specific disease type
strongly suspected) positive negative negative positive
OR
Epithelial Skin Antibodies 0090299 and Endomysial Antibodies 0050734
Screen for Screen for Herpes Gestationis
Paraneoplastic
Immunobullous Immunobullous Will resolve post pregnancy
positive, titer >1:10 Pemphigus Likely to occur with subsequent pregnancies
diseases diseases
May occur with other hormonal changes, including
negative
contraception

Monitor for developing


immunobullous disease
IgA endomysial
Repeat screening: antibodies* IgG basement
In 3-6 months for persistent IgA basement membrane IgG cell surface IgA cell surface
membrane zone
unexplained disease zone epidermal, dermal
In 6-12 weeks for rapidly or combined epidermal/
evolving disease dermal pattern Pemphigus
Order Pemphigus IgA
Skin biopsy for granular Antibodies 0092106 as
or fibrillar IgA Epidermal Combined Dermal IgG Desmoglein-1 and additional or separate test
pattern epidermal/dermal pattern Desmoglein-3 0090649 for suspected IgA
negative positive Linear IgA disease
(Note: Necessary if pemphigus
pemphigoid panel testing
Epidermolysis was not ordered) negative positive
Monitor treatment Pemphigoid bullosa acquisita
positive
response Desmoglein-1 Desmoglein-3
Repeat Dermatitis Epithelial Basement Monitor treatment positive positive
skin biopsy herpetiformis Membrane Zone IgA Bullous Pemphigoid response
Antibodies 0092057 Antigens IgG Epithelial Basement IgA
P. foliaceus P. vulgaris
OR BP180 and BP230 Membrane Zone IgG Pemphigus
(most common) (most common)
Epithelial Skin 0092566 Antibodies 0092056 OR OR
Antibody 0090299 (Note: Necessary if OR P. erythematosus P. vegetans
pemphigoid panel Epithelial Skin
Monitor treatment testing was not Antibody 0090299
response ordered)
IgA endomysial* Monitor treatment
and Tissue Monitor treatment response
Transglutaminase response Pemphigus IgA
Antibodies IgA, IgG Monitor treatment response Pemphigus Panel Antibodies 0092106
0097709, 0056009 Pemphigoid Panel 0092001 0090650

* For Endomysial Antibodies, a screening IgA tissue transglutaminase assay (ELISA) can be ordered OR request Endomysial Antibody test by indirect immunofluorescence (IgA and/or IgG) with or without accompanying
IgA and/or IgG tissue transglutaminase assay through the Immunodermatology Laboratory.

© 2006-2008 ARUP Laboratories. All Rights Reserved. Revised 9/2/08 www.arupconsult.com

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