Background information regarding Immunofluorescence:
The salt split skin assay shows localization of immunoreactivity to the roof of the saline induced split typical for bullous pemphigoid.
Specimen provided must not have an in vivo split. The salt split skin separation is performed in vitro.
Direct immunofluorescent studies will show homogeneous linear staining along the dermal-epidermal junction. Salt split skin studies show localization to the floor of the saline induced split characteristic of anti-epiligrin pemphigoid (Magro CM and Wu R et al Int J Dermatol 2012).
Vasculopathic disorders with distinctive Immunofluorescent Profiles
Dr. Cynthia Magro, Director of Dermatopathology at Weill Cornell Medical College and Professor of Pathology and Laboratory Medicine, is one of the leading experts in the country in the interpretation of immunofluorescent specimens. She has authored over 250 papers in the field of Dermatopathology. Many of her papers focus on the application of direct and indirect immunofluorescent studies in the evaluation of disease and in the enhancement of our understanding of the pathophysiologic aspects of autoinflammatory disease. She has a special interest in the application of immunofluorescence in the evaluation and diagnosis of various connective tissue disorders including lupus erythematosus, mixed connective tissue disease, and dermatomyositis along with distinctive vascular syndromes, including Degos disease, cocaine induced retiform purpura, and antiphospholipid antibody syndrome. She has developed the anti-endothelial cell antibody assay to assess for circulating anti-endothelial cell antibodies which are characteristically present in certain diseases such as scleroderma, dermatomyositis, and antiphospholipid antibody syndrome. She has also applied her experience in the field to evaluate neurologic disease, using information gleaned from the immunofluorescent biopsy to predict underlying mechanisms leading to neurologic disease, most notably small fiber neuropathy. Dr. Magro has also applied her expertise in the field of cutaneous immunofluorescence in evaluation of autoinflammatory conditions of the lung, publishing the only comprehensive paper and book chapter devoted to the role of direct and indirect immunofluorescence in the assessment of medical lung disease. Reprints of her work in the field of immunofluorescence are available on request. Please see bibliography below.
Magro CM, Roberts-Barnes J, Crowson AN. Direct immunofluorescence testing in the diagnosis of immunobullous disease, collagen vascular disease, and vascular injury syndromes. Dermatol Clin. 2012 Oct;30(4):763-98.
Camp BJ, Magro CM. Cutaneous macroglobulinosis: a case series. J Cutan Pathol. 2012 Oct;39(10):962-70
Magro CM, Rossi A, Poe J, Manhas-Bhutani S, Sadick N. The role of inflammation and immunity in the pathogenesis of androgenetic alopecia. J Drugs Dermatol. 2011 Dec;10(12):1404-11.
Magro CM, Wu R. Anti-laminin 5 pemphigoid: a case report of a benign cutaneous confined non-cicatricial variant. Int J Dermatol. 2012 Jan;51(1):79-85.
Swaminath A, Magro CM, Dwyer E. Refractory urticarial vasculitis as a complication of ulcerative colitis successfully treated with rituximab. J Clin Rheumatol. 2011 Aug;17(5):281-3.
Magro CM, Poe JC, Kim C, Shapiro L, Nuovo G, Crow MK, Crow YJ. Degos disease: a C5b-9/interferon-Î±-mediated endotheliopathy syndrome. Am J Clin Pathol. 2011 Apr;135(4):599-610.
Rossi A, Reszko A, Leach J, Magro CM. Combined bullous pemphigoid and pemphigus vulgaris in an 18-year-old female. J Cutan Pathol. 2010 Sep;37(9):991-6. Epub 2009 Jul 14.
Magro CM, Dyrsen ME. The use of C3d and C4d immunohistochemistry on formalin-fixed tissue as a diagnostic adjunct in the assessment of inflammatory skin disease. J Am Acad Dermatol. 2008 Nov;59(5):822-33
Magro CM, Schaefer JT, Waldman J, Knight D, Seilstad K, Hearne D. Terbinafine-induced dermatomyositis: a case report and literature review of drug-induced dermatomyositis. J Cutan Pathol. 2008 Jan;35(1):74-81
Magro CM, Ross P, Marsh CB, Allen JN, Liff D, Knight DA, Waldman WJ, Cowden DJ. The role of anti-endothelial cell antibody-mediated microvascular injury in the evolution of pulmonary fibrosis in the setting of collagen vascular disease. Am J Clin Pathol. 2007 Feb;127(2):237-47.
Vasil KE, Magro CM. Cutaneous vascular deposition of C5b-9 and its role as a diagnostic adjunct in the setting of diabetes mellitus and porphyria cutanea tarda. J Am Acad Dermatol. 2007 Jan;56(1):96-104.
Patterson CC, Ross P Jr, Pope-Harman AL, Knight DA, Magro CM. Alpha-1 anti-trypsin deficiency and Henoch-SchÃ¶nlein purpura associated with anti-neutrophil cytoplasmic and anti-endothelial cell antibodies of immunoglobulin-A isotype. J Cutan Pathol. 2005 Apr;32(4):300-6.
Wusirika R, Ferri C, Marin M, Knight DA, Waldman WJ, Ross P Jr, Magro CM. The assessment of anti-endothelial cell antibodies in scleroderma-associated pulmonary fibrosis. A study of indirect immunofluorescent and western blot analysis in 49 patients with scleroderma. Am J Clin Pathol. 2003 Oct;120(4):596-606.
Magro CM, Pope Harman A, Klinger D, Orosz C, Adams P, Waldman J, Knight D, Kelsey M, Ross P Jr. Use of C4d as a diagnostic adjunct in lung allograft biopsies. Am J Transplant. 2003 Sep;3(9):1143-54
Magro CM, Allen J, Pope-Harman A, Waldman WJ, Moh P, Rothrauff S, Ross P Jr. The role of microvascular injury in the evolution of idiopathic pulmonary fibrosis. Am J Clin Pathol. 2003 Apr;119(4):556-67
Crowson AN, Mihm MC Jr, Magro CM. Cutaneous vasculitis: a review. J Cutan Pathol. 2003 Mar;30(3):161-73. Review.
Crowson AN, Magro CM, Usmani A, McNutt NS. Immunoglobulin A-associated lymphocytic vasculopathy: a clinicopathologic study of eight patients. J Cutan Pathol. 2002 Nov;29(10):596-601
Crowson AN, Magro C. The cutaneous pathology of lupus erythematosus: a review. J Cutan Pathol. 2001 Jan;28(1):1-23. Review.
Magro CM, Morrison C, Pope-Harman A, Rothrauff SK, Ross P Jr. Direct and indirect immunofluorescence as a diagnostic adjunct in the interpretation of nonneoplastic medical lung disease. Am J Clin Pathol. 2003 Feb;119(2):279-89.
Crowson AN, Magro CM. The role of microvascular injury in the pathogenesis of cutaneous lesions of dermatomyositis. Hum Pathol. 1996 Jan;27(1):15-9.
Crowson AN, Magro CM. Diltiazem and subacute cutaneous lupus erythematosus-like lesions. N Engl J Med. 1995 Nov 23;333(21):1429.
Crowson AN, Magro CM. Deposition of membrane attack complex in cutaneous lesions of lupus erythematosus. J Am Acad Dermatol. 1994 Sep;31(3 Pt 1):515-6.
Magro CM, Crowson AN, Harrist TJ. The use of antibody to C5b-9 in the subclassification of lupus erythematosus. Br J Dermatol. 1996 May;134(5):855-62.