Clinicopathological study of vesiculobullous lesions of the skin and the diagnostic utility of immunofluorescence

Abstract

Introduction: Vesicobullous disorders represent a heterogenous group of dermatoses with protean manifestations in which the primary lesion is a vesicle or a bulla on the skin or mucous membrane or both. These lesions can be extremely debilitating, may have serious sequelae, and even fatal, necessating early treatment and intervention to prevent further morbidity and mortality. Many of these blistering diseases mimic each other clinically, Histopathology together with immunofluorescence are used for diagnosing vesiculobullous lesions of skin. Materials and Methods: The present study is done at out institute for a period of 3 years from 2016 to 2019 All the vesiculo bullous lesions which we received during this period have been included in our study. We received a total of 42 cases during our study period. Light microscopic examination followed by DIF was done for definitive diagnosis. The pattern and distribution of immune complex deposits was analysed under fluorescence microscope and correlated with histological findings Results: Bullous pemphigoid was the common vesiculobullous disease (38.09%) followed by pemphigus vulgaris. dif showed linear type of immune deposits in epidermal basement membrane zone in bullous pemphigoid and in pemphigus vulgaris intercellular lace like deposition of immune complexes was seen. Conclusion:Vesiculobullous disorders represent a heterogeneous group of dermatoses Punch biopsy of the skin is a simple, inexpensive, safe OPD procedure, causing minimal discomfort lesions and DIF studies are an adjunct to the histomorphology. DIF which is the gold standard and sensitive test in making a definitive diagnosis aids in distinguishing non immune lesions from immune mediated lesions which pose a diagnostic dilemma both clinically and histologically An integrated approach of clinical findings in conjunct with histomorphology and DIF assist in accurate diagnosis and proper patient management.

Clinicopathological Features of Patients with Vesiculobullous Diseases Referred to Dermatology Clinic of Afzalipour Hospital, Kerman, Iran

“…In the present study, the mean age of patients was 45.09 years, which was compatible with other studies (12,17,18,21). The earliest age of disease onset was observed in EB and Darier.…”

“…Friction blister 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 ( 0 study, the rarest one was papule (23). In the present study, lesions were more commonly observed on the upper limb and trunk, consistent with Tunisia and India studies (4,17). Also, the most common deposited Ig was IgG, compatible with the Mittal study (18).…”

“…In the Murthy study, similar to the present study, a lack of inflammation in the blister cavity was reported in Darier disease and Hailey-Hailey disease (19). Furthermore, the correlation of clinical diagnosis with histological diagnosis varied between 64.2% and 90.90% (11,12,(17)(18)(19)(20)(21)(22). In the current study, there was a complete agreement between the clinical and final pathological diagnoses, with 73.8% concordance with the first diagnosis.…”

Morphological Spectrum of Vesiculobullous Skin Lesions: An Institutional Perspective

“…Similar to our findings, they found bullous pemphigoid to be the most common vesiculobullous skin lesion (38.1%), followed by pemphigus vulgaris. They concluded that skin punch biopsy is a reliable technique to diagnose vesiculobullous skin lesions, with DIF as an adjunctive tool [ 4 ]. Alternatively, in another study, involving 68 cases of vesiculobullous skin lesions, pemphigus vulgaris was the most common histopathological diagnosis.…”

Histomorphological study of vesiculobullous lesions of skin: a study of 66 cases at tertiary care center

“…The number of patients presenting with clinical features like vesicles and bullae, involvement of mucous membranes, Nikolsky's sign and Bulla spread sign is different in various studies conducted in India. The difference may be due to prevalence of the diseases, severity and stage of the disease at presentation and status 11,14,19 Study done by Jindal et al showed pemphigus vulgaris was the commonest vesiculobullous disorder with 31.6% cases followed by dermatitis herpentiformis with 18.3% cases. 20 In the present study the plane of separation was intraepidermal-in majority of the cases (30.30%) followed by subcorneal (28.78%) and sub epidermal planes (24.24%).…”