Direct immunofluorescence (DIF) and indirect immunofluorescence (IIF) tests on skin biopsy are being done mostly in academic teaching hospitals. These tests provide a useful diagnostic aid to dermatologists. Immunohistology and serology can, in conjunction with histology, provide considerable help in delineation and diagnosis of various skin disorders as well as systemic diseases with skin involvement, e.g. systemic lupus erythematosus. Immunofluorescence (IF) studies have now become an invaluable supplement to clinical and histological examination in a variety of dermatological diseases. These skin diseases now include not only bullous and connective tissue disorders, vasculitides, and conditions such as lichen planus, but also the scaling dermatoses, notably psoriasis. In this review article, we share our experience of providing such a diagnostic facility for more than 30 years in a large tertiary care health center in North India and also help to outline the conditions, which can be diagnosed confidently, and others where IF can help in confirming a diagnosis or the immune component of the disease. The article also deals with handling of skin biopsy specimens and interpretation of biopsy findings on DIF and IIF examination.

Vital capacity can be measured as forced vital capacity (FVC), slow vital capacity (SVC), and inspiratory vital capacity (IVC). Although it is well known that the latter two are generally greater, a systematic comparison of the three in subjects with different degrees of airways obstruction has not been made. Sixty asthmatics and 20 normal subjects performed maneuvers for measurement of FVC, SVC, and IVC on a dry, rolling-seal spirometer. The severity of airways obstruction in asthmatics was classified as mild, moderate, and severe. There was no significant difference between FVC, SVC, and IVC in normal subjects. However, the three measurements of vital capacity were significantly different in all subgroups of asthmatics. FVC was smaller than both SVC and IVC. The differences were more marked in patients with moderate and severe degrees of airways obstruction. The differences between SVC and IVC were small and clinically not important. Forced expiratory volume in 1 sec (FEV1) expressed as percent of FVC, SVC, and IVC, was not different in normals and asthmatics with mild airways obstruction. The ratios were significantly different in asthmatics with moderate and severe airways obstruction. FEV1/IVC ratio was the lowest in both the groups followed by FEV1/SVC and FEV1/FVC. IVC and SVC are greater than FVC in patients with airways obstruction. This difference increases as the degree of obstruction increases. The difference between SVC or IVC and FVC serves as an indicator of air trapping. Both FVC and IVC could be measured and the largest VC used to calculate the FEV1/VC ratio because this increases the sensitivity of spirometry in detecting airways obstruction.

Aspirates from 162 epidermal inclusion cysts (EIC) from 157 patients were analyzed in order to elaborate on specific cytologic features. The most common site involved was the head and neck region (96 cases; 59.2%). The maximum patients were in the 3rd and 4th decades of life. Aspirates from EIC showed a clear background, with high cellularity, and nucleate and anucleate squames. Keratinous material was seen in some cases but the amount was less compared with the cellular elements. In 31 cases, a diagnosis of infected EIC was made on the basis of dense inflammatory infiltrate in addition to the squames. Histopathology was available in 56 cases out of which EIC was diagnosed in 45 cases. The remaining 11 cases were dermoid cyst (5 cases), branchial cyst (2 cases), pilomatricoma (2 cases), and sebaceous and thyroglossal cyst (1 case each). Thus, EIC should be differentiated from other squamous cell containing lesions.

The DIF of skin in conjunction with histopathology gives the best diagnostic yield. It is invaluable in confirming the diagnosis of small vessel vasculitides and bullous lesions of skin and can be used as an additional tool to pinpoint the diagnosis of systemic and localized autoimmune diseases involving the skin.

Vulvar cancer is an uncommon malignancy of the female genital tract in developing countries, accounting for 3% of gynaecological cancers. Here, cervical cancer is an everyday problem; ovarian cancer is the second commonest gynaecological cancer; endometrial is less common and vulvar cancer is rare. It is advanced at admission, though is a visible cancer. Records of women who had histopathologically proven vulvar cancer over 24 years were analysed for epidemiological status and preventive possibilities. During the analysis period, 9,419 total cancer cases were diagnosed; 4,726 (50.17%) were in women. A total of 39.52% (1,868 of 4,726) were gynaecological; 18 cases were vulvar (0.38% of the 4,726 women with cancer) and 0.96% of the 1,868 gynaecological cancer cases. Decreasing trends were 2.25% between 1984 and 1988, down to 0.33% between 2004 and 2008. Leading presenting complaints were: dyspareunia, 88.88% (16 of 18 patients); pruritus 13; ulcers 14; vulvar swelling 12 and urinary problems 13. Dystrophy was present in 8 of 18 cases. Overall, four had stage I, one stage II, three stage III and four stage IV disease at admission; all at labia majora or minora, some too advanced to know origin. Four women with metastasis in the lungs, liver and bones could only be given palliation. While vulvar cancer is uncommon, advanced disease at admission is a concern. Awareness is essential. Research is needed as to why cervical cancer is common and vulvar uncommon, as HPV plays a major aetiological role, so that cervical cancer can be prevented, with early diagnosis, management of vulvar cancer should also be available.