Track: Clinical Studies

Abstract:

Background: Direct immunofluorescence (DIF) remains a cornerstone in diagnosing autoimmune blistering diseases. Standard teaching and published guidelines traditionally favor punch biopsies, citing higher diagnostic yield and reduced risk of inadequate sampling. Objective: To highlight clinical situations where shave biopsies, when performed thoughtfully, can produce diagnostically adequate or superior DIF specimens. Methods and Observations: Our institutional experience demonstrates that, in select vesicular or elevated lesions—particularly in bullous pemphigoid and pemphigus vulgaris—shave biopsies better preserve lesional morphology and offer clearer visualization of the basement membrane zone (BMZ) compared to punch techniques. These advantages are most notable when targeting perilesional skin with an intact epidermis. Representative cases illustrate that proper lesion selection, precise sampling, and maintenance of epidermal integrity can yield high-quality DIF specimens without the depth provided by a punch biopsy. Conclusion: While punch biopsies remain appropriate in many cases, selective use of shave biopsies may optimize diagnostic yield, especially for cosmetically sensitive sites or when rapid, minimally invasive sampling is preferred. Broader recognition of these scenarios could help clinicians tailor biopsy techniques to the lesion and patient, challenging the one-size-fits-all approach to DIF specimen collection.

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Anamika Singh