Immunodermatology laboratory

Aiding in the evaluation of cutaneous autoimmune disease

Contacts

  • Immunodermatology laboratory
    St John's Institute of Dermatology
    St Thomas' Hospital
    Westminster Bridge Road
    London SE1 7EH

    Tel: 020 7188 6364
    Email: viapath.imf@nhs.net 
    Opening hours for telephone enquiries: Monday-Friday, 9am-5pm

  • Member of staff in the immunofluorescence laboratory

The immunodermatology laboratory uses immunofluorescence, ELISAs and other techniques to aid in the evaluation of patients with suspected or established cutaneous autoimmune disease.

As well as diagnostic work, our laboratory has an active research programme in cutaneous immunology, including the mechanisms, diagnosis and therapy of autoimmune blistering disease, often in collaboration with colleagues in the UK and internationally.

Founded in 1975, the lab initially functioned as an experimental unit, developing immunofluorescence techniques and establishing immunofluorescence as a key diagnostic technique in dermatology. We are now regarded as a skin immunofluorescence referral centre for the UK.

  • Referrals

    Please contact the laboratory before sending specimens to discuss specimen type, transportation, and charges. Specimens should be sent to the address at the top of this webpage.

    Requests are accepted from consultants and hospitals in the UK and internationally, for both NHS and private patients.

    If a specimen is urgent, please notify the laboratory and ensure contact information is provided.

    We are happy to provide telephone or written advice to clinical colleagues on the interpretation of results and management of patients with immunologically mediated skin disease.

  • Specimen requirements for direct immunofluorescence (DIF)

    This is a one-step procedure for detecting in-vivo deposition of immunoglobulins, complement components and fibrinogen in a patient's skin.

    Procedure for biopsy

    Whenever possible, biopsy a single fresh small blister including adjacent clinically uninvolved skin (perilesional). For a large blister, biopsy edge of blister and adjacent uninvolved skin (perilesional). 

    Cut the perilesional end and send for IF studies and the remaining blister for histology.

    For uninvolved skin, a 3mm punch biopsy is sufficient.  

    Condition

    Biopsy site(s) for IF studies

    Pemphigus (all forms)

    Perilesional and uninvolved (buttock)

    Pemphigoid (all forms)

    Perilesional and uninvolved (thigh or arm)

    Pemphigoid (herpes) gestationis

    Perislesional

    Epidermolysis bullosa acquisita

    Perilesional

    Linear IgA bullous dermatosis (LAD & CBDC)

    Perilesional and uninvolved (buttock)

    Dermatitis herpetiformis

    Uninvolved (buttock)

    Discoid lupus erythematosus

    Lesional

    Systemic lupus erythematosus

    Lesional and uninvolved (non-sun exposed, buttock)

    Lichen planus

    Lesional

    Porphyria

    Lesional

    Vasculitis

    Lesional

    Amyloid

    Lesional

  • Specimen requirements for indirect immunofluorescence (IIF)

    This is a two-step procedure for demonstrating circulating autoantibodies in a patient's serum.

    One 5ml serum-separator tube (SST) of blood (typically yellow/gold-coloured top) or separated serum (0.5ml minimum) should be sent to the laboratory. 

  • Specimen requirements for enzyme-linked immunosorbent
    assay (ELISA)

    The laboratory performs the following 5 assays for quantification and monitoring of specific circulating antibodies:

    Antibody Disease Positivity threshold 
    Desmoglein 1 Pemphigus   >30 U/ml
    Desmoglein 3 Pemphigus  >30 U/ml
    BP180/collagen XVII  Pemphigoid  >20 U/ml
    BP230/dystonin Pemphigoid  >10 U/ml
    Collagen VII Epidermolysis bullosa acquisita   >6 U/ml

    Each ELISA can be performed on 5 µl of serum (or blister fluid) and results are reported in (arbitrary) U/ml. ELISAs are normally performed in combination with indirect IMF studies, hence sample requirements are identical to those for indirect IMF. Relevant ELISA testing will be determined by lab staff, dependent on immunofluorescence results and information provided on the request form.

  • Results and costs

    We aim to report direct immunofluorescence results five working days and indirect immunofluorescence results eight working days following specimen receipt.

    Results are available to clinicians by telephone on 020 7188 6364. No information will be given to patients or their relatives. 

    Please contact the laboratory to discuss tests required and charges.

  • Transportation

    Transport of specimens for direct immunofluorescence to the laboratory should be in Michel's transport medium which can be obtained from our department on request. 

    Michel's medium can be stored at room temperature for one year without deterioration.  

  • Staff

    Consultants:

    • Dr Richard Groves FRCP (Director) - consultant dermatologist
    • Dr Catherine Stefanato MD - consultant dermatopathologist

    Other staff:

    • Dr John Mee – head of laboratory
    • Riffat Sana-Aslam – biomedical scientist
    • Chinele Ukachukwu – biomedical scientest
    • Lynn Westmarland – biomedical scientist
    • Pushpaharan Balachandran – associate practitioner
    • Uchini Kosgodage – medical laboratory assistant

Visit the International Pemphigus and Pemphigoid Foundation website for more information about pemphigus and pemphigoid.