A STUDY OF ROLE OF DIRECT IMMUNOFLUORESCENCE IN DIAGNOSIS OF CUTANEOUS VESICULOBULLOUS DISORDER AND ITS HISTOPATHOLOGICAL CORRELATION -A STUDY OF 30 CASES

Abstract

Background

Autoantibodies against antigens in intercellular substance or dermo-epidermal junction results in potentially debilitating cutaneous vesiculobullous disorder. As there is clinical overlap among this group, histopathological examination helps to generate differential diagnosis based on site of vesicle, presence, intensity and composition of inflammatory infiltrate. While direct immunofluorescence (DIF) is an expensive advance test which particularly contributes in diagnosis when histopathological findings are inconclusive.

Aim

To evaluate role of histopathological and direct immunofluorescence study in diagnosis of cutaneous vesiculobullous disorder.

Method

Present study is an analytical study of 30 clinically suspected cases of cutaneous vesiculobullous disorder carried out at Department of Pathology, S.S.G Hospital and Medical College, Baroda over a period of 1 year. Two biopsies were taken from each patient. One lesional skin biopsy for histopathological examination and one perilesional skin biopsy for direct immunofluorescence test. Findings of both were correlated and a final diagnosis for each patient was arrived.

Results

Out of 30 cases, pemphigus vulgaris was the most common with total of 13 cases (43.3%) followed by bullous pemphigoid 9 cases (30%), Dermatitis herpetiformis 3 cases (10%), pemphigus foliaceous 2 cases (6.7%), Linear IgA Dermatosis 2 cases (6.7%) and Cicatricial pemphigoid 1 case (3.3%). DIF test results of 29 cases concurred with histopathological findings. One case was negative for DIF test.

Conclusion

Histopathological examination and Direct Immunofluorescence both are required for making a definitive diagnosis of vesiculobullous lesions having overlapping and diverse presentation. DIF is particularly important when histopathological findings are non-diagnostic or non-confirmatory.