Skin biopsy, histology, immunofluorescence and skin autoantibodies
How to choose, take and send a skin biopsy (punch, shave, excision, deep incisional), reading a histology report by reaction pattern, direct and indirect immunofluorescence patterns, BP180/BP230 and desmoglein 1 and 3 ELISA, and the handling errors that waste a biopsy.
Tier 2Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- A skin biopsy answers a question only if you choose the right lesion, the right technique and the right container. Most failed biopsies are handling errors.
- Histology goes in formalin. Direct immunofluorescence (DIF) needs fresh tissue in Michel's medium or saline. Culture needs fresh tissue in a sterile pot.
- Read a histology report by its reaction pattern (spongiotic, psoriasiform, interface, vasculitic, granulomatous, panniculitis, blistering), then match it to the clinical picture.
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Sources
- Therapeutic Guidelines: Dermatology (skin biopsy; blistering disorders)AU/NZTherapeutic Guidelines Limited (eTG complete), current eTG edition, accessed November 2026 (topic version not verified)
- RCPA Manual: pemphigus and pemphigoid antibodies; skin biopsy immunofluorescenceAU/NZRoyal College of Pathologists of Australasia, online edition, accessed November 2026
- Venning VA et al. British Association of Dermatologists' guidelines for the management of bullous pemphigoid 2012. Br J Dermatol 2012;167:1200-14British Association of Dermatologists, 2012 (no newer BAD edition found, November 2026)
- Harman KE et al. British Association of Dermatologists' guidelines for the management of pemphigus vulgaris 2017. Br J Dermatol 2017;177:1170-201British Association of Dermatologists, 2017
- Borradori L et al. Updated S2K guidelines for the management of bullous pemphigoid initiated by the European Academy of Dermatology and Venereology (EADV). J Eur Acad Dermatol Venereol 2022;36:1689-704European Academy of Dermatology and Venereology, 2022
- Joly P et al. Updated S2K guidelines on the management of pemphigus vulgaris and foliaceus initiated by the European Academy of Dermatology and Venereology (EADV). J Eur Acad Dermatol Venereol 2020;34:1900-13European Academy of Dermatology and Venereology, 2020
- Last updated
- 14 November 2026
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