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Immunodermatology laboratory

Aiding in the evaluation of cutaneous autoimmune disease

Dermatology

Coronavirus: dermatology update

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Contacts

  • Immunodermatology laboratory
    St John's Institute of Dermatology
    1st floor, South Wing
    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

  • Research in the dermatology lab

The immunodermatology laboratory is the only dedicated skin immunofluorescence referral laboratory in the UK. We receive approximately 7,500 samples per year from over 100 centres around the UK. 

Please refer to the following documents or select the relevant header below for
further information:

  • 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, separate biopsies should be taken for histology and DIF.
    • For uninvolved perilesional or lesional skin, a 3 or 4mm punch biopsy is sufficient.
    ConditionBiopsy site(s) for DIF studies

    Pemphigus (all forms)*

    Perilesional uninvolved

    Pemphigoid (all forms)*

    Perilesional uninvolved

    Pemphigoid gestationis*

    Perilesional uninvolved

    Epidermolysis bullosa acquisita*

    Perilesional uninvolved

    Linear IgA bullous dermatosis (LABD & CBDC)*

    Perilesional uninvolved

    Dermatitis herpetiformis*

    Perilesional uninvolved

    Discoid lupus erythematosus (DLE)

    Lesional

    Systemic lupus erythematosus (SLE)

    Lesional and uninvolved (non-sun exposed)

    Lichen planus

    Lesional

    Porphyria

    Lesional

    Vasculitis

    Lesional

    Amyloidosis

    Lesional

    *For accurate direct immunofluorescence diagnosis of these immunobullous diseases, biopsy of normal perilesional skin or mucosa is essential. Lesional and/or heavily inflamed biopsies are sub-optimal for this technique and are unlikely to yield diagnostically useful results.

  • 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 gold-coloured top) or separated serum (0.5ml minimum) should be sent to the laboratory within 48 hours of collection (one month for separated serum) following storage at 4°C. 

    Serum samples must be labeled with patient name and date of birth.

    Please note that the laboratory no longer accepts blister fluid specimens for processing.

  • 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   >20 RU/ml

    Each ELISA can be performed on 5 µl of serum 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 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 – clinical scientist/laboratory manager
    • Asif Khan – senior biomedical scientist
    • Sarah Ward – biomedical scientist
    • Donna Magsumbol – biomedical scientist
    • Lynn Westmarland – biomedical scientist
    • Simon Fayyaz – associate practitioner
    • Jhelisa Ayoade – medical laboratory assistant

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