Derm SAQs ·
Special stains and immunofluorescence in dermatopathology — SAQ
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Stem
A 78-year-old woman develops tense bullae on urticarial plaques over the trunk and limbs. You plan biopsies. Separately, a farmer has a chronic annular scaly plaque treated with clobetasol for months without response.
Questions
a) For the elderly woman, specify the ideal biopsy sites and transport media for (i) routine histopathology and (ii) direct immunofluorescence. (3 marks)
b) List the expected DIF pattern in bullous pemphigoid and name two serologic antigen tests that may support the diagnosis. (2 marks)
c) How does salt-split skin immunofluorescence help separate bullous pemphigoid from epidermolysis bullosa acquisita? (2 marks)
d) Which special stains would you request on the farmer’s biopsy if tinea incognito is suspected, and why might H&E alone miss the diagnosis? (3 marks)