Original Research Article
Year: 2016 | Month: November | Volume: 3 | Issue: 11 | Pages: 98-102
Histopathological and Direct Immunofluorescence Spectrum of Vesiculobullous Skin Disorders
Dr. Gautam Goyal1*, Dr. Hilda Fernandes2*, Dr. Nada C.K1**
1PG Resident, 2Prof and HOD
*Father Muller Medical College, Mangalore, **A J Institute of Medical Sciences, Mangalore.
Corresponding Author: Dr. Gautam Goyal
ABSTRACT
Vesiculobullous lesions comprises of a group of heterogeneous skin diseases, treatment of which greatly depend upon correct diagnosis. There is overlap in clinical and histopathological features of various autoimmune vesiculobullous lesions. Such overlap is more so with subepidermal lesions where the role of Immunofluorescence is critical. A diagnosis based solely on clinical and histological findings may not be accurate. Direct Immunofluorescence is extremely useful in distinguishing closely related groups. [1] This forms the basis of this study which aims to evaluate the role of Direct Immunofluorescence and Histopathology in diagnosis of vesiculobullous lesions. A total of 58 skin biopsies of suspected vesiculobullous lesions were studied over a period of 2 years. For Direct Immunofluorescence biopsies Optimally Diluted Fluorescein Isothiocyanate (FITC) labeled monospecific Immunoglobulins viz IgG, IgA, IgM and C3 was layered over the sections and incubated. Sections were then examined under fluorescent microscope and the type and pattern of Immunoreactant. For histopathological analysis formalin fixed skin biopsy of the vesiculobullous lesion was processed, stained with Hand E stain and then observed under light microscope Slight male preponderence was noted with 55.2% males as oppose to 44.8% females. Bullous pemphigoid constituted the most common vesiculobullous disorders with 27.9%% followed by pemphigus vulgaris 22.4%. Peak incidence was seen between 40-49 yrs for pemphigus and 70 to 80 in Bullous Pemphigoid. DIF was done for all cases.DIF showed positive findings. In 15 cases there was discordance between the clinical diagnosis and the final diagnosis offered considering both histopathological and DIF findings. 5 cases showed discordance between histopathological diagnosis and DIF findings. Out of these cases in 3 cases DIF was helpful and in another 2 cases final diagnosis was arrived by Histopathology.DIF was thus helpful in few overlapping cases. It should be used in conjugation with Histopathology and Clinical features to get the best diagnostic yield.
Keywords: Direct Immunofluorescence, Vesiculobullous, Pemphigus.