Immunodermatology Laboratory

Immunodermatology testing is essential for the correct diagnosis and treatment of many diseases affecting epithelial organs including skin, mucous membranes, gastrointestinal and respiratory tracts. Tests are performed on blood and tissues that are sent to our laboratory from medical facilities and referring physicians across the United States. The Immunodermatology Laboratory at the University of Utah and its team of Board Certified Immunodermatologists are committed to providing reliable, rapid, and comprehensive diagnostic testing. We welcome all requests from physicians seeking immunodermatology testing. 

Physicians

Kristin M. Leiferman, M.D.

John J. Zone, M.D. 

Laboratory Staff

Marjorie Allen - Lead Medical Technologist

Our Services

Immunodermatology Laboratory at the University of Utah Department of Dermatology offers a complete service for direct and indirect immunofluorescence testing:

  • Consultation for clinical questions for patient care and test interpretation
  • Timely reporting
  • Comparison charts and graphs with sequential serum testing
  • Digital images of positive results available upon request
  • Local courier services and expedited prepaid shipping
  • Complimentary specimen kits
  • Laboratory services billing department
  • Extensive participating insurance list

Dr. Kristin Leiferman and Dr. John Zone are available for consultation regarding your patient's skin disease and to provide advice regarding testing and interpretation of results. They can be reached at 801-581-6465.

Immunodermatology Laboratory Brochure

Lab Credentials:

The University of Utah Immunodermatology Laboratory participates in the College of American Pathologists (CAP) Laboratory Accreditation Program and has Clinical Laboratory Improvement Amendments (CLIA) certification through the Centers for Medicare & Medicaid Services (CMS).

CAP Immunodermatology Certificate

CLIA License #:46D0681916

CAP logo

Immunodermatology tests are important in diagnosing the following. Follow the links for images of typical test results and biopsy site selection instructions.

Disease Images

Indirect Immunofluorescence of Pemphigus Serum in Calcium Buffer on Intact Human Skin

IgG cell surface (intercellular substance) staining (40x)

IgG cell surface (intercellular substance) staining (40x)

Direct Immunofluorescence of Pemphigoid Skin Biopsy

IgG linear basement membrane zone (20x) and C3 linear basement membrane zone (40x)

IgG cell surface (intercellular substance) staining (40x) C3 linear basement membrane zone (40x)

Indirect Immunofluorescence of Pemphigoid Serum on Human Split Skin Substrate

IgG epidermal pattern (roof of split) (20x)

IgG epidermal pattern (roof of split) (20x)

Indirect Immunofluorescence of Epidermolysis Bullosa Acquisita Serum on Human Split Skin Substrate

IgG dermal pattern (floor of split)

Indirect Immunofluorescence of Epidermolysis Bullosa Acquisita Serum on Human Split Skin Substrate

Indirect Immunofluorescence of Linear IgA Bullous Dermatosis Serum on Human Split Skin Biopsy

IgA epidermal pattern (roof of split) (40x)

LABD

Direct Immunofluorescence of Dermatitis Herpetiformis Skin Biopsy

IgA granular basement membrane zone with stippling in dermal papillae (40x)

Dermatitis Herpetiformis

Endomysial Antibody IgA Indirect Immunofluorescence of Serum on Human Umbilical Cord Substrate

Endomysium staining (40x)

Indirect Immunofluorescence of Eosinophil Granule Major Basic Protein in Urticaria Skin Biopsy

Direct Immunofluorescence of Lupus Erythematosus Skin Biopsy (Lichenoid changes may also be observed)

C3 granular basement membrane zone (40x)

Lupus Erythematosus Skin Biopsy

Direct Immunofluorescence of Lichen Planus of Lichenoid Reaction Skin Biopsy

IgM scattered and clumped cytoids

Lichen Planus or Lichenoid Reactions

Direct Immunofluorescence of Cutaneous Vasculitis (including Urticarial Vasculitis) Skin Biopsy

Fibrinogen blood vessels (vessels may also stain for IgG, IgM, IgA and C3; IgA vascular staining is characteristic of Henoch Schönlein purpura)

Direct Immunofluorescence of Cutaneous Vasculitis (including Urticarial Vasculitis) Skin Biopsy

Direct Immunofluorescence of Porphyria or Pseudoporphyria Skin Biopsy

C3 granular and fibrinogen weak thick basement membrane zone and perivascular

Direct Immunofluorescence of Porphyria or Pseudoporphyria Skin Biopsy Direct Immunofluorescence of Porphyria or Pseudoporphyria Skin Biopsy

Indirect Immunofluorescence of Eosinophil Granule Major Basic Protein in Urticaria Skin Biopsy

Few intact eosinophils and extensive extracellular granular major basic protein deposition

urticaria

Immunodermatology Testing Services

Tissue Specimens (skin and mucous membrane)

Biopsy Collection Instructions (Procedure to obtain a biopsy for direct immunofluorescence)

Biopsy Site Selection (Biopsy site is critical for precise immunofluorescence results.

Serum Specimens (peripheral blood serum specimens)

Test Descriptions

  • Direct Immunofluorescence (DIF) of cutaneous tissue (skin and mucosa)
    The DIF test is performed on skin or mucosal biopsy specimens. All biopsy specimens are examined for the presence and staining pattern of immunoglobulins (IgG, IgM, IgA), third component of complement (C3), and fibrinogen. An optimal analysis is obtained when the specimen is procured from an appropriate site (biopsy site information) using the proper technique (see specimen collection instructions) and accompanied by a separate fixed tissue specimen for histological examination (see below). Accompanying serum for indirect immunofluorescence and/or enzyme-linked immunosorbent assays is diagnostically helpful for immunobullous diseases. [top]

  • Histological examination of fixed tissue (H&E and other stains as indicated)
    Histological examination is performed on skin or mucosal biopsy specimens submitted in formalin. If accompanying tissue for direct immunofluorescence, separate reports are issued incorporating the direct immunofluorescence results along with the histological findings. All fixed specimens are examined following hematoxylin and eosin (H&E) staining; other stains are performed and examined as indicated. [top]

  • Eosinophil major basic protein (eMBP) of tissue
    This is an indirect immunofluorescence test on tissue to detect eosinophil involvement in disease and is performed on formalin-fixed tissue. Eosinophils often disrupt in tissue, losing morphologic identity. This test, which detects an eosinophil granule protein, released upon eosinophil activation, is particularly useful for detecting eosinophil activity in inflammatory diseases including allergic diseases in a variety of epithelial tissues (skin, conjunctiva, upper and lower respiratory tract, gastrointestinal tract) and connective tissue (fibrotic processes). [top]

  •  Basement membrane zone antibodies by Indirect Immunofluorescence (IIF) of serum
    This IIF test is performed on serum to detect the presence and amount of circulating IgG and/or IgA antibodies to epidermal/epithelial antigens. Semiquantitative levels of antibodies are reported as titers. Basement membrane zone antibodies are helpful in diagnosing and distinguishing subepidermal immunobullous diseases such as pemphigoid, epidermolysis bullosa acquisita and linear IgA bullous disease. [top]

  •  Cell surface (also known as intercellular substance and pemphigus) antibodies by Indirect Immunofluorescence (IIF) of serum
    This IIF test is performed on serum to detect the presence and amount of circulating IgG and/or IgA antibodies to epidermal/epithelial antigens. Semiquantitative levels of antibodies are reported as titers. Cell surface antibodies are helpful in diagnosing pemphigus, including pemphigus vulgaris, pemphigus foliaceus, pemphigus vegetans and pemphigus erythematosus for IgG cell surface antibodies and IgA pemphigus for IgA cell surface antibodies. Levels of antibodies correlate with disease activity in pemphigus. [top]

  •  Endomysial Antibodies (EMA) by IIF of serum
    This IIF test is performed to detect the presence and levels of circulating IgA and/or IgG endomysial antibodies (EMA). IgA EMA are present in essentially all patients with celiac disease and in 70-80% of patients with dermatitis herpetiformis who are not adhering to a gluten-free diet. The test is highly specific and sensitive for both celiac disease and dermatitis herpetiformis. EMA levels can be used to monitor adherence to a gluten-free diet.  IgG EMA antibodies may be found in patients with celiac disease and dermatitis herpetiformis who also have IgA antibodies and may be helpful in a diagnostic testing panel. IgG EMA may occur earlier than IgA antibodies in celiac disease, and they may useful in aiding the diagnosis of these diseases in patients who are IgA deficient. [top]

  •  Pemphigoid (Herpes) gestationis factor by complement fixing IIF of serum
    This test is a complement-fixing indirect immunofluorescence test of serum that is useful in the diagnosis of pemphigoid (herpes) gestationis, an immunobullous disease of pregnancy. [top]
  •  Paraneoplastic pemphigus screen by IIF of serum on rodent substrates
    This test is performed on rodent bladder, liver, and heart substrates with patient's serum suspected of having paraneoplastic pemphigus. Patients with paraneoplastic pemphigus develop autoantibodies to epithelium that can be detected on rodent substrates. This test aids in the diagnosis of paraneoplastic pemphigus and should be used in combination with both cell surface and basement membrane zone indirect immunofluorescence. [top]
  •  Desmoglein 1 and desmoglein 3 IgG antibodies for pemphigus by enzyme linked immunosorbent assays (ELISAs)
    The cell surface antigens in pemphigus to which patients develop circulating autoantibodies are desmoglein 1 for pemphigus foliaceus (and pemphigus erythematosus) and desmoglein 3 for pemphigus vulgaris (and pemphigus vegetens). Overlap occurs among the types of pemphigus. Detection of the antibodies aids in the diagnosis of and subtyping of pemphigus, and antibody levels correlate with disease activity. [top]
  •  Bullous pemphigoid antigens, BP 180 and BP 230, IgG antibodies by ELISAs
    The primary basement membrane zone antigens in pemphigoid to which patients develop circulating autoantibodies are bullous pemphigoid antigen 1, BP230, and bullous pemphigoid antigen 2 (BP180). Antibody levels to either or both antigen correlates with disease activity in bullous pemphigoid. [top]
  •  Tissue Transglutaminase (tTg) IgA and/or IgG Antibodies in serum by ELISA
    The presence of these antibodies aids the diagnosis of gluten sensitive enteropathy-associated diseases including celiac disease and dermatitis herpetiformis; IgA tTG antibody levels are useful for monitoring patient's adherence to a gluten-free diet. Tissue transglutaminase is an autoantigen in the endomysium to which autoantibodies in gluten-sensitive enteropathies react. IgG tTG antibodies may be present along with or in the absence of IgA tTG antibodies and may be present in patients with IgA deficiency. [top]
  • Total Serum IgA 
    This test is useful for determining levels of IgA in serum. IgA deficiency is common and, if present, may affect the diagnostic value of testing for IgA antibodies. [top]

If you would like a specimen kit, please call, e-mail or fax your request to our laboratory. Your specimen kit(s) with prepaid Fed-Ex return & labels will be sent to you promptly.

Contact Us

E-Mail: Immunoderm@hsc.utah.edu
Toll Free Phone: 866-266-5699
Local Phone: 801-581-7139

Dr. John Zone & Dr. Kristin Leiferman are available for consultation regarding your patient's skin disease and to provide advice regarding testing and interpretation of results. They can be reached through the laboratory or Dermatology administrative office at 801-581-6465.

Specimen Kit Contents

Kit map Sticker

  • Two tubes with Michel's transport medium (bright green) for skin biopsies (one specimen per tube) for direct immunofluorescence
  • One tube of formalin for fixed tissue histological examination
  • One small empty cryovial for serum
  • Labels for vials
  • Immunodermatology Request Form
  • Information & instruction sheets

Take the time to review our biopsy instructions and specimen transport information.

Specimen Transport Information

Complete the Immunodermatology Request Form. The following patient data are needed for interpretation:

  • Patient's full name
  • Birthdate (if patient is underage, guarantor name and birthdate are also needed)
  • Gender
  • Clinical diagnosis and brief history
  • Biopsy site
  • Exposure of site to sun (sun exposed, non-sun exposed)
  • Relationship to lesional skin (perilesional, involved, uninvolved)
  • Procurement date of all specimens submitted

Online Supply/Kit Request Form

For your convenience, you can order your supplies/kits by completing our online form: Online Supply/Kit Request Form

Mail the specimen(s) in the return mailer at ambient temperature, OR...,

if mailer and transport medium are not available, ship the tissue specimen frozen on dry ice by express mail, packing in enough dry ice to stay frozen until receipt in laboratory. Do NOT mail vials filled with transport medium or formalin on dry ice. Serum should be shipped at ambient temperature.

The specimen kit mailer has a return label. If a mailer is not used, the shipping address is:

Immunodermatology Laboratory
Department of Dermatology
University of Utah Health Care
30 North 1900 East
4A330 School of Medicine
Salt Lake City, UT. 84132-2409

Patient Billing

Patients may benefit from billing for Immunodermatology testing through their physician because insurance plans may not cover services performed at the University of Utah resulting in direct patient billing; the Immunodermatology billing office staff is knowledgeable and will arrange billing plans to best serve patients and physicians. Specimens also may be sent through the national reference laboratory, ARUP.

Department of Dermatology Billing Office:

Hours: Monday - Friday 8 AM to 4 PM
Local: 801-741-8840
Toll free: 1-800-245-0357

Please Note: Patients are responsible for all medical charges associated with the laboratory services provided at our facility. To verify specific coverage, patients should contact their insurance provider. Insurance participation is subject to change over time. Should you have questions about your billing statement, please contact the Dermatology Billing Office at toll-free 1-800-245-0357. Your physician is not privy to specific information about your University of Utah Immunodermatology laboratory billing services.

Click here to view our Insurance Participation List

Our Immunodermatology Laboratory Office is open from 8 a.m. - 4:30 p.m., Mountain Time, Monday - Friday. We will return all calls and inquires received after normal business hours the next business day. Our office will be able to assist you with the orders of complimentary specimen kits, testing and billing questions.

Immunodermatology Laboratory
Department of Dermatology
University of Utah Health Care
30 North 1900 East
4A330 School of Medicine
Salt Lake City, Utah 84132

Phone: (801) 581-7139
Toll-Free: 1-866-266-5699
Fax: (801) 585-5695
Email: immunoderm@hsc.utah.edu

Hours of Operation:

University of Utah Immunodermatology Laboratory – Hours of Operation

Monday-Friday:  8 a.m. – 4:30 p.m. MT

Saturdays & Sundays: Closed

Holidays: Closed (New Year’s Day, Martin Luther King, Jr. Day, Presidents’ Day, Memorial Day, Independence Day, Pioneer Day, Labor Day, Thanksgiving Day, Day after Thanksgiving, Christmas Day).