{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T02:11:19Z","timestamp":1777515079153,"version":"3.51.4"},"reference-count":17,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2018,4,22]],"date-time":"2018-04-22T00:00:00Z","timestamp":1524355200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Cutan Med Surg"],"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Bullous pemphigoid (BP) is the most common subepidermal autoimmune disorder characterized by tense bullae. It is associated with circulating autoantibodies against BP antigen-1 and BP antigen-2. Diagnosis is based upon clinical, histopathologic, and immunopathologic examination. Direct immunofluorescence (DIF) of perilesional skin highlights C3 with or without IgG in a linear pattern along the basement membrane.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>We hypothesized that repeat biopsies may be required for a definitive DIF diagnosis of BP, as initial DIF evaluation may result in a false-negative result.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A retrospective chart review was conducted on 1143 specimens collected for evaluation for BP. Cases from 2 Vancouver Coastal Health Authority laboratories from 2006 to 2016 were reviewed. Results were interpreted as positive, negative, or indeterminate based on pathologic description and specimen quality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>After meeting the inclusion criteria, 739 specimens were further evaluated. There were 289 cases of BP in the 10-year period. Five patients (1.73%; 95% confidence interval [CI], 1.50-1.96) required a second biopsy to support a BP diagnosis, and within this group, 1.04% of the 289 (95% CI, 0.811-1.27) were true successive negative-to-positive DIF results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>DIF is the most reliable test used to diagnose BP; however, a small percentage of patients will initially have a negative result. False-negative or indeterminate results may be due to specimen sampling from lesional skin or due to a subthreshold quantity of immune complexes in the skin. Repeat biopsy is warranted despite an initial negative DIF if BP is clinically suspected.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1203475418773359","type":"journal-article","created":{"date-parts":[[2018,4,22]],"date-time":"2018-04-22T03:51:35Z","timestamp":1524369095000},"page":"472-475","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":16,"title":["Bullous Pemphigoid: A 10-Year Study of Discordant Results on Direct Immunofluorescence"],"prefix":"10.1177","volume":"22","author":[{"given":"Jessica G.","family":"Fudge","sequence":"first","affiliation":[{"name":"Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Vancouver, BC, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard I.","family":"Crawford","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Vancouver, BC, Canada"},{"name":"Department of Pathology and Laboratory Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2018,4,22]]},"reference":[{"key":"bibr1-1203475418773359","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-4362.1998.00271.x"},{"key":"bibr2-1203475418773359","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2230.2003.01419.x"},{"issue":"4","key":"bibr3-1203475418773359","first-page":"730","volume":"50","author":"Inchara YK","year":"2007","journal-title":"Indian J Pathol Microbiol"},{"key":"bibr4-1203475418773359","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2013.07.009"},{"key":"bibr5-1203475418773359","doi-asserted-by":"publisher","DOI":"10.1016\/0030-4220(75)90421-1"},{"key":"bibr6-1203475418773359","doi-asserted-by":"publisher","DOI":"10.1111\/1523-1747.ep12259692"},{"key":"bibr7-1203475418773359","doi-asserted-by":"publisher","DOI":"10.1038\/jid.1968.94"},{"key":"bibr8-1203475418773359","doi-asserted-by":"publisher","DOI":"10.1111\/1523-1747.ep12283737"},{"key":"bibr9-1203475418773359","doi-asserted-by":"publisher","DOI":"10.1002\/jcla.1860030509"},{"key":"bibr10-1203475418773359","doi-asserted-by":"publisher","DOI":"10.1111\/j.1346-8138.1990.tb03008.x"},{"key":"bibr11-1203475418773359","doi-asserted-by":"publisher","DOI":"10.1007\/BF00371823"},{"key":"bibr12-1203475418773359","doi-asserted-by":"publisher","DOI":"10.1007\/BF00918084"},{"key":"bibr13-1203475418773359","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0560.2002.290504.x"},{"key":"bibr14-1203475418773359","doi-asserted-by":"publisher","DOI":"10.1111\/1523-1747.ep12260627"},{"key":"bibr15-1203475418773359","doi-asserted-by":"publisher","DOI":"10.1016\/S0190-9622(85)80035-9"},{"key":"bibr16-1203475418773359","doi-asserted-by":"publisher","DOI":"10.1016\/S0190-9622(89)70054-2"},{"key":"bibr17-1203475418773359","doi-asserted-by":"publisher","DOI":"10.2310\/7750.2014.14004"}],"container-title":["Journal of Cutaneous Medicine and Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1203475418773359","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1203475418773359","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1203475418773359","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T15:54:05Z","timestamp":1777391645000},"score":1,"resource":{"primary":{"URL":"http:\/\/journals.sagepub.com\/doi\/10.1177\/1203475418773359"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,4,22]]},"references-count":17,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2018,9]]}},"alternative-id":["10.1177\/1203475418773359"],"URL":"https:\/\/doi.org\/10.1177\/1203475418773359","relation":{},"ISSN":["1203-4754","1615-7109"],"issn-type":[{"value":"1203-4754","type":"print"},{"value":"1615-7109","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,4,22]]}}}