A Study on Cytoclinical Correlation in Immunobullous, Spongiotic, and Viral Vesicular Skin Lesions

Abstract

BACKGROUND Tzanck smear serves as a primary diagnostic method in diseases like immunobullous disorders, viral blisters, candidiasis, Hailey-Hailey disease, Darier disease, toxic epidermal necrolysis and cutaneous neoplasms. The aim of the study was to investigate the correlation between cytoclinical, histopathology and immunofluorescence findings in chronic immunobullous diseases and to study the sensitivity of Tzanck smear findings in chronic immunobullous diseases, viral vesicular lesions, and spongiotic dermatitis. METHODS 181 patients with chronic immunobullous diseases, spongiotic and viral vesicular skin lesions who attended the department of Dermatology and Venereology between April 2013 to October 2014 in our tertiary care centre were studied. RESULTS Out of 181 patients studied, 66 cases were chronic immunobullous diseases, 65 cases were viral vesicular lesions and 50 cases were eczema. Tzanck smear showing acantholytic cells in pemphigus vulgaris has a sensitivity of 93.75%. For pemphigus foliaceus and pemphigus vegetans sensitivity was 100%. Direct immunofluorescence (DIF) was 100% sensitive for pemphigus vulgaris and histopathology and DIF correlated in 100%. Tzanck smear with eosinophils correlated with clinical diagnosis of bullous pemphigoid in 70% cases, while histopathology correlated in 100% and DIF positivity was in 95% cases. Tzanck smear has a sensitivity of 70.77% in herpetic infections, 75% in allergic contact dermatitis and 72.72 in irritant contact dermatitis. CONCLUSIONS In chronic immunobullous diseases, Tzanck smear helps the dermatologist to make a primary diagnosis with ease and rapidity without much discomfort to the patient. Though the sensitivity of Tzanck smear in viral infections is low, it can be performed which can narrow down the list of differential diagnosis.