Laser Scanning Confocal Microscopy for Diagnostics of Brunsting-Perry Type Cicatrical Pemphigoid Cases, along with Review of Literature

Background: In the literature there are a few reported cases of cicatrical pemphigoid Brunsting-Perry type (CPBP). CPBP is well clinically characterized by clinical research, however is heterogeneous in a term of immunological findings. Laser scanning confocal microscopy (LSCM) is a helpful tool for diagnostics of cicatricial pemphigoid in general, especially when circulating antibodies are not detectable. Objectives: Application of LSCM for the first time in a case with clinical features of CPBP and review the literature. Methods: Skin biopsy was taken for LSCM studies. LSCM technique relies on comparison between the location of IgG/IgA deposits and basement membrane zone (BMZ) markers: antibodies directed to laminin 332 served as a marker of lower part of lamina lucida, whereas antibodies to type IV collagen served as a marker of lamina densa. Immunoglobulins are labeled with anti-human IgG-FITC (green staining), whereas BMZ markers are labeled with anti-mouse IgG-Cy 5 (red). Both fluorescence are simultaneously excited and overlayed by appropriate laser lines and asseses by computer program. Results: LSCM studies disclosed both IgG and IgA located below laminin-332 and above type IV collagen, characteristic of cicatricial pemphigoid.