For which vesiculobullous diseases are indirect immunofluorescence helpful?

It is most commonly used in pemphigus vulgaris (less commonly in bullous pemphigoid), epidermolysis bullosa acquisita, and cicatricial pemphigoid. This procedure identifies antibodies present in the circulation; therefore, serum is submitted for evaluation. It is most commonly used to obtain an antibody titer to help monitor disease activity. Again, only a few laboratories perform this testing routinely, so consultation with the laboratory prior to obtaining the specimen is recommended to ensure appropriate handling of the specimen. Enzyme-linked immunosorbent assay (ELISA) testing for these same serum antibodies has now become commercially available and is both sensitive and specific. ELISA has largely replaced indirect immunofluorescent studies as the study of choice for antibody titers and for detecting certain antibodies such as BP180, BP230, desmoglein 1, and desmoglein 3 in blistering diseases.