About

Kristin M. Leiferman, M.D. is a Dermatologist and Immunodermatologist with expertise in immune-mediated skin diseases, especially diagnosis and management of allergic skin diseases and diagnosis of autoimmune blistering diseases that affect skin and mucous membranes. She has board certification in Dermatology and Dermatological Immunology/Diagnostic and Laboratory Immunology. Dr. Leiferman is a Professor of Dermatology and Co-Director of the Immunodermatology Laboratory at the University of Utah, where she has examined thousands of specimens for diagnosing autoimmune blistering diseases. Her specialized focus is on allergy-related inflammation, including mast cell- and eosinophil-associated diseases, and laboratory diagnosis. She is passionate about skin health in general, from acne to skin cancer, prevention, and treatment.

Research topics

• Medicine
• Pathology
• Immunology
• Gastroenterology
• Nuclear medicine
• Internal medicine
• Dermatology

Selected publications

• Anti‐ <scp>p200</scp> Pemphigoid in an Infant Clinically Mimicking Linear <scp>IgA</scp> Disease

  Pediatric Dermatology · 2026-04-13

  article

  We report a 10-month-old boy with annular/polycyclic vesicles on his face, neck, trunk, and extremities that clinically and histomorphologically indicated linear IgA disease (LAD)/chronic bullous disease of childhood (CBDC); however, the immunofluorescence findings and serum positivity for anti-laminin β4 antibodies were consistent with anti-p200 pemphigoid. His condition improved with prednisolone but recurred during tapering; remission was achieved following dapsone administration. Anti-p200 pemphigoid often resembles bullous pemphigoid clinically and is characterized similarly by subepidermal bullae with linear IgG antibody reactivity and C3 basement membrane zone (BMZ) localization, but differs in its target antigen.

  PublisherDOI

• Diffuse Dermal Immunoglobulin Deposition and Monoclonal Gammopathy

  JAMA Dermatology · 2026-04-08

  articleOpen access

  This case series describes patients with diffuse dermal immunoglobulin deposition identified using direct immunofluorescence.

  PublisherOA PDFDOI

• Assessment of Cutaneous and Mucosal Direct Immunofluorescence Testing Practices in the US

  JAMA Dermatology · 2025-04-04 · 4 citations

  article

  Importance: Direct immunofluorescence (DIF) testing has been an important ancillary tool for the diagnosis of various inflammatory mucocutaneous conditions for more than 50 years. Current DIF test panels are based on historical clinical descriptions; few studies have rigorously addressed preanalytical, analytical, and/or postanalytical aspects, and even fewer have been replicated or validated. Recent unresolved key issues include whether DIF testing and test panels should be triaged or truncated based on clinical indication or histopathologic findings. Objective: To assess levels of consensus regarding practical aspects of DIF testing among immunodermatology testing specialists in the US. Design, Setting, and Participants: Using modified Delphi methods with a priori characterized criteria, a survey containing 54 statements pertaining to DIF testing was created and distributed to assess consensus. Statements not initially reaching consensus were discussed in 2 live virtual sessions, which were supplemented by relevant literature review and free-text survey comments. These statements were then reassessed in a second survey. Immunodermatology testing specialists in US academic institution-based and independent laboratories were invited based on serving as immunodermatology laboratory medical directors, authoring pertinent literature, or delivering relevant talks at major conferences or by referral. The first survey was conducted from January to February 2024, and the second survey was conducted from March to April 2024. Main Outcomes and Measures: The primary measured outcome was degree of consensus for various DIF testing practice, including DIF testing triage by histopathology/dermatopathology findings and DIF testing panel tailored truncations by clinical indication. Results: A total of 23 respondents to the survey invitation had a mean (SD) of 18.5 (11.1) years and median (range) of 20.0 (1.5-46.0) years in immunodermatology laboratory practice. Consensus was achieved for 46 of 54 statements (85.2%) in the initial survey and for an additional 4 statements in the second survey (50 of 54 [92.6%]). Strong consensus was found against tailored truncation of DIF panel based on the clinical indication in the first survey round. The general acceptability of triaging specimens for DIF testing based on histopathology findings remained without consensus after both surveys. Conclusions and Relevance: Overall, participating US specialists in immunodermatology laboratory testing agreed on many practical aspects of DIF testing, including matters not queried previously. The findings also revealed areas of continued controversy and identified issues for prioritized future study.

  PublisherDOI

• The true extent of eosinophil involvement in disease is unrecognized: the secret life of dead eosinophils

  Journal of Leukocyte Biology · 2024-06-26 · 14 citations

  reviewOpen access1st authorCorresponding

  Eosinophil-mediated pathophysiology is tissue destructive and tissue altering with proinflammatory, prothrombotic, and profibrotic effects. The distinctive morphology of an eosinophil reveals a cytoplasm chockfull of unique granules, and the granule proteins have numerous toxic effects on cells, tissues, and organs. Eosinophils are not found in most human tissues, and eosinophil involvement in diseased tissues generally is identified by cell infiltration on histopathologic examination. However, eosinophils characteristically lose their structural integrity and deposit granules and granule proteins at sites of inflammation. Hence, their participation in tissue damage may be underrecognized or entirely overlooked. The eosinophil major basic protein 1 is a toxic granule protein and, when deposited, persists in tissues. Major basic protein 1 deposition can be regarded as a footprint of eosinophil activity. Analyses of numerous eosinophil-related diseases have demonstrated clear-cut evidence of major basic protein 1 deposition in affected tissues where eosinophils were not recognized by hematoxylin and eosin tissue staining and light microscopy. Eosinophil granule protein deposition, as exemplified by localization of major basic protein 1, especially when disproportionately greater than cellular infiltration, emerges as a biomarker of hidden eosinophil-related pathophysiology. Consequently, current assessments of recognized eosinophils may vastly underestimate their role in disease.

  PublisherDOI

• Biologic therapy in rare eosinophil-associated disorders: remaining questions and translational research opportunities

  Journal of Leukocyte Biology · 2024-03-08 · 5 citations

  reviewOpen access

  Rare eosinophil-associated disorders (EADs), including hypereosinophilic syndrome, eosinophilic granulomatosis with polyangiitis, and eosinophilic gastrointestinal disorders, are a heterogeneous group of conditions characterized by blood and/or tissue hypereosinophilia and eosinophil-related clinical manifestations. Although the recent availability of biologic therapies that directly and indirectly target eosinophils has the potential to dramatically improve treatment options for all EADs, clinical trials addressing their safety and efficacy in rare EADs have been relatively few. Consequently, patient access to therapy is limited for many biologics, and the establishment of evidence-based treatment guidelines has been extremely difficult. In this regard, multicenter retrospective collaborative studies focusing on disease manifestations and treatment responses in rare EADs have provided invaluable data for physicians managing patients with these conditions and helped identify important questions for future translational research. During the Clinical Pre-Meeting Workshop held in association with the July 2023 biennial meeting of the International Eosinophil Society in Hamilton, Ontario, Canada, the successes and limitations of pivotal multicenter retrospective studies in EADs were summarized and unmet needs regarding the establishment of guidelines for use of biologics in rare EADs were discussed. Key topics of interest included (1) clinical outcome measures, (2) minimally invasive biomarkers of disease activity, (3) predictors of response to biologic agents, and (4) long-term safety of eosinophil depletion. Herein, we report a summary of these discussions, presenting a state-of-the-art overview of data currently available for each of these topics, the limitations of the data, and avenues for future data generation through implementation of multidisciplinary and multicenter studies.

  PublisherOA PDFDOI

• Pemphigus Vulgaris With Esophageal Involvement in an Atopic Child Successfully Treated With Dupilumab

  Pediatric Dermatology · 2024-12-11 · 4 citations

  articleOpen access

  We report the case of a 3-year-old boy who was diagnosed with childhood pemphigus vulgaris having developed oral lesions, gastrointestinal symptoms with esophageal involvement, and failure to thrive. He had a markedly increased total serum IgE level and peripheral blood eosinophilia. The pemphigus was recalcitrant to conventional therapies and, based on the coexisting characteristics of Th2 immune deviation, he was treated with dupilumab and has had sustained clinical improvement since starting treatment. The case illustrates the importance of recognizing pemphigus vulgaris in childhood, considerations for dupilumab therapy, and a potential pathophysiological links between pemphigus autoantibodies in early life, Th2 inflammation, and atopic disorder.

  PublisherOA PDFDOI

• Does Eosinophil Depletion in Gastroenteric Diseases Associated With the Hypereosinophilic Syndrome Teach Us Whether Normal Humans Need Eosinophils in 2022?

  The Journal of Allergy and Clinical Immunology In Practice · 2022-06-01

  letterSenior author
  PublisherDOI

• Proposed refined diagnostic criteria and classification of eosinophil disorders and related syndromes

  Allergy · 2022 · 150 citations

  • Medicine
  • Immunology

  Eosinophilia and eosinophil activation are recurrent features in various reactive states and certain hematologic malignancies. In patients with hypereosinophilia (HE), HE-induced organ damage is often encountered and may lead to the diagnosis of a hypereosinophilic syndrome (HES). A number of known mechanisms and etiologies contribute to the development of HE and HES. Based on these etiologies and the origin of eosinophils, HE and HES are divided into primary forms where eosinophils are clonal cells, reactive forms where an underlying reactive or neoplastic condition is detected and eosinophils are considered to be "non-clonal" cells, and idiopathic HE and HES in which neither a clonal nor a reactive underlying pathology is detected. Since 2012, this classification and the related criteria have been widely accepted and regarded as standard. However, during the past few years, new developments in the field and an increasing number of markers and targets have created a need to update these criteria and the classification of HE and HES. To address this challenge, a Working Conference on eosinophil disorders was organized in 2021. In this conference, a panel of experts representing the relevant fields, including allergy, dermatology, hematology, immunology, laboratory medicine, and pathology, met and discussed new markers and concepts as well as refinements in definitions, criteria and classifications of HE and HES. The outcomes of this conference are presented in this article and should assist in the diagnosis and management of patients with HE and HES in daily practice and in the preparation and conduct of clinical trials.

  PublisherOA PDFDOI

• Diagnostics for Dermatologic Diseases with Autoantibodies

  The Journal of Applied Laboratory Medicine · 2021 · 13 citations

  1st authorCorresponding
  • Medicine
  • Immunology
  • Dermatology

  BACKGROUND: Dermatologic diseases with autoantibodies were recognized early as autoimmunity became accepted as a pathogenic immunologic concept. Laboratory testing to identify disease-defining autoantibodies and investigate their role in pathophysiology has evolved since. CONTENT: Blistering dermatologic diseases, profiled by autoantibody production, target epithelial components critical in cell-cell and cell-matrix adhesion, resulting in epithelial separation and other characteristic features of the disorders. This review covers the clinical indications for dermatologic disease-related autoantibody testing, the specifics of procuring specimens to test, the available diagnostic tests, and information provided by the testing. Atypical, uncharacteristic, and less well-known clinical and autoantibody profiles as well as several of the many future prospects for expansion of the testing applications are elaborated on in the online Data Supplement. SUMMARY: Autoantibody-associated dermatologic diseases are acquired immunologic disorders that have considerable clinical implications affecting essential barrier functions of skin and mucous membranes and causing discomfort, including pain and pruritus. Certain of the diseases can have life-threatening manifestations, and treatments can have significant side-effects. The skin diseases may presage other clinical associations that are important to recognize and treat. Laboratory testing aids in the diagnosis of these diseases through identification of the autoantibodies and is essential for prompt and precise knowledge of the disease type for prognosis, further clinical evaluations, and treatment decisions.

  PublisherOA PDFDOI

• Mucosal linear IgA disease with esophageal involvement responsive to ustekinumab

  JAAD Case Reports · 2021-07-10 · 3 citations

  articleOpen access

  Linear IgA bullous dermatosis (LABD), or linear IgA disease, is a rare autoimmune mucocutaneous blistering disease with vesicles and bullae characteristically arranged in an annular or arciform pattern on the skin and, less common, mucosal involvement manifesting as vesicles, erosions, and/or ulcers. We present a rare case of a patient who had Crohn's disease and LABD with primarily mucosal involvement, including oral, esophageal, and vaginal lesions, who responded well to ustekinumab therapy.

  PublisherDOI

Recent grants

• NIH Grant R01AR036008

  NIH · $551k · 1995

• NIH Grant R23AR036008

  NIH · $142k · 1989

• NIH Grant U01AI034577

  NIH · $1.9M · 1997

Frequent coauthors

• Gerald J. Gleich

  University of Utah

  77 shared

• P. Braquet

  Centre Hospitalier de Luxembourg

  22 shared

• Ernest N. Charlesworth

  20 shared

• Amy D. Klion

  17 shared

• Dietrich Kraft

  17 shared

• Sandra Valtier

  59th Medical Wing

  16 shared

• Terry J. George

  Mayo Clinic

  16 shared

• Bonnie A. Whisman

  Wilford Hall Medical Center

  16 shared

Education

• M.D.

  Mayo Medical School

• Other

  Mayo Clinic

Awards & honors

• Proposed refined diagnostic criteria and classification of e…
• Contemporary consensus proposal on criteria and classificati…
• The hypereosinophilic syndromes: current concepts and treatm…