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Diagnosis of Bullous Diseases

The diagnosis of bullous disorders is made by thorough clinical evaluation and is confirmed by histopathologic and immunofluorescent examination. Light microscopy will provide information on whether or not there is an inflammatory infiltrate and on the nature of the inflammatory infiltrate. In addition, it is a useful tool to determine the level of blister formation, that is intraepidermal or subepidermal. Electron microscopic examination provides more detailed information on the blister cleavage plane, but it is not routinely used for diagnostic purposes. Immunofluorescence is a laboratory technique for demonstrating the presence of tissue-bound and circulating antibodies and complement. Tissue-bound antibodies are demonstrated by direct immunofluorescence and circulating antibodies are demonstrated by indirect immunofluorescence. These laboratory techniques, in conjunction with a detailed history and a careful physical examination will lead the clinician to the correct diagnosis in most circumstances.