A Cross-sectional Study of Clinical, Histopathological and Direct Immunofluorescence Spectrum of Vesiculobullous Disorders

Arundhathi, S; Ragunatha, S; Mahadeva, K C

doi:10.7860/jcdr/2013/7019.3760

Cited by 13 publications

(17 citation statements)

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“…Most cases presented as vesicles. These patterns were comparable with the study done by Arundhathi et al 14…”

Section: Vb Lesionssupporting

confidence: 93%

“…All the 18 cases were concordant with clinical diagnoses (100%) in our study. Krishnamurthy et al 15 reported 64.8% concordance, while Arundhathi et al 14 conclusIon Inflammatory dermatoses of the superficial cutaneous reactive unit are very common and comprise a wide, complex variety of clinical conditions. Morphology remains the gold standard for their diagnosis.…”

Section: Clinicopathological Correlation Of Vb Lesionsmentioning

confidence: 99%

“…Among them, the pemphigus group is the commonest. 14,15 Histopathological diagnoses are based on the level of blister separation, inflammatory infiltrate, and altered keratinocytes, such as acanthocytes. 14,16 In the present study, the distribution of VB lesions was generalized.…”

Section: Vb Lesionsmentioning

confidence: 99%

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Inflammatory Dermatoses of the Superficial Cutaneous Reactive Unit—Study of Morphological Features with Clinical Correlation

Raj¹,

Dinesh²,

Kumar³

2019

The Journal of Medical Sciences

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Background and objectives: Inflammatory dermatoses of the superficial cutaneous reactive unit are a common and complex variety of clinical conditions. This study was undertaken to perform a detailed morphological evaluation of lesions classified in this category, and to correlate the clinical details to arrive at the most appropriate diagnosis. Methodology: Skin biopsies of clinically diagnosed/suspected cases of inflammatory dermatoses were processed and stained with hematoxylin and eosin (H&E), followed by microscopic examination. Results: A total of 160 skin biopsies of superficial inflammatory dermatoses were studied. Lesions were categorized into papular/nonvesiculobullous (non-VB) (142 cases/88.75%) and VB (18 cases/11.25%) lesions. Papular lesions were frequent in males, with a peak incidence in the fourth decade. Patients presented mostly with pigmented plaques and papules over the extremities. Papular lesions were categorized based on epidermal changes: 8 cases without epidermal changes and 134 with epidermal changes. Lesions with epidermal changes were further categorized into interface dermatitis (60 cases), psoriasiform dermatitis (58 cases), and spongiotic dermatitis (16 cases). Commonly reported lesions were lichen planus (LP) with its variants followed by psoriasis vulgaris. VB lesions were common in the third and fourth decades, predominantly in females. These patients presented mostly with generalized vesicles. Common lesions reported were erythema multiforme (seven cases) and pemphigus vulgaris (six cases). Of the 160 cases, clinicopathological concordance was seen in 156 cases (97.5%) and discordance in 4 cases (2.5%). Interpretation and conclusion: The incidence of superficial inflammatory dermatoses in our study was comparable with those reported in other studies. Despite advances in molecular techniques, morphology remains the gold standard for the diagnosis and prognosis of many inflammatory dermatoses. This study emphasizes the importance and utility of a systematic approach to superficial inflammatory dermatoses which is relevant from the treatment perspective.

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“…Most cases presented as vesicles. These patterns were comparable with the study done by Arundhathi et al 14…”

Section: Vb Lesionssupporting

confidence: 93%

Section: Clinicopathological Correlation Of Vb Lesionsmentioning

confidence: 99%

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Inflammatory Dermatoses of the Superficial Cutaneous Reactive Unit—Study of Morphological Features with Clinical Correlation

Raj¹,

Dinesh²,

Kumar³

2019

The Journal of Medical Sciences

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“…The diagnostic value of DIF has been presented by various authors as the lesions closely mimic each other [3,[8][9][10][11]. The maximum number of cases in the present study were of PV, followed by BP.…”

Section: Discussionsupporting

confidence: 53%

Utility of Direct Immunofluorescence in Cutaneous Autoimmune Bullous Disorders

Brar¹,

Sharma²,

Nauhria³

et al. 2021

Cureus

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BackgroundAutoimmune bullous disorders (AIBD) are a heterogeneous group of disorders with substantial clinical overlap associated with blistering of skin or mucosa. AimsThe present study aimed to study the histopathological spectrum and evaluate the utility of direct immunofluorescence (DIF) on snap-frozen and paraffin-embedded sections in resolving the differential diagnosis of AIBD and connective tissue disorders of the skin. We also compared the efficacy of DIF on paraffin versus the snap-frozen sections in diagnosing AIBD. MethodsThe present study was conducted for three years (2017-2019) and included 27 biopsies. We also included a retrospective analysis that included 25 biopsies collected over three years (2014)(2015)(2016)(2017). Histopathological examination and DIF were conducted on all samples. ResultsPemphigus vulgaris was the most common autoimmune cutaneous disorder constituting 37% (n = 10) in prospective and 36% (n = 9) in the retrospective study. DIF showed a specificity of 81.25% in our prospective study. While on the paraffin-embedded sections, it showed a specificity of 66.6% in our retrospective study. In the prospective study, DIF on paraffin-embedded sections had a positivity rate of 43.75% as compared to 81.25% in DIF done on snap-frozen sections. ConclusionDIF is a sensitive tool for the diagnosis as well as distinguishing immune-mediated bullous disorders from other lesions primarily when performed on snap-frozen sections. The diagnostic yield is enhanced by DIF in cases that pose a diagnostic dilemma both clinically and histologically. The final diagnosis depends on all clinical, histopathological and immunofluorescence findings.

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“…[9] In the study done by Arundhathi et al , DIF was positive in 24 out of 36 cases of PV and three out of six cases of PF. [18]…”

Section: Discussionmentioning

confidence: 99%

A clinicopathological and immunofluorescence study of intraepidermal immunobullous diseases

Basu

Chatterjee

et al. 2019

Indian J Dermatol

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Context: Autoimmune blistering diseases (AIBDs) are characterized by autoantibodies directed against antigens of skin. Direct immunofluorescence (DIF) study helps in confirming the diagnosis where histopathology alone is noncontributory. Aims: This study aimed to evaluate the clinicopathological and DIF features of intraepidermal AIBD and to assess their relative diagnostic significance. Materials and Methods: It was an institution-based observational study. A total of 34 patients were studied over a period of 1½ years in the Department of Pathology in collaboration with the Department of Dermatology of a tertiary care hospital. The clinical, pathological, and DIF features were evaluated and documented. Statistical Analysis: Data were analyzed by statistical tests using GraphPad InStat. Results: Pemphigus vulgaris (PV) was the predominant type with 18 (53%) cases followed by 15 (44%) cases of pemphigus foliaceus (PF) and a single case of pemphigus erythematosus (PE). The age of the patients ranged from 17 to 85 years. Overall, there was a female preponderance in the study group. The most common presenting feature was pruritus (58.82%). Tzanck smear showed the presence of acantholytic cells in thirty (88.24%) patients. Characteristic histopathological features were present in all the cases of PV and PF except one case of PF which was found to be a case of PE. DIF study showed intraepidermal deposition of intercellular immunoglobulin G (IgG) and C3 both in PV and PF. The case of PE showed epidermal “antinuclear antibody” staining with IgG. Conclusion: Immunofluorescence study may be used as an additional tool for confirmation of diagnosis where histopathology alone is inconclusive.

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A Cross-sectional Study of Clinical, Histopathological and Direct Immunofluorescence Spectrum of Vesiculobullous Disorders

Abstract: Background: Accurate diagnosis of vesiculobullous lesions of skin requires evaluation of clinical, histopathologic and immunofluorescence findings.

Cited by 13 publications

References 1 publication

Inflammatory Dermatoses of the Superficial Cutaneous Reactive Unit—Study of Morphological Features with Clinical Correlation

Inflammatory Dermatoses of the Superficial Cutaneous Reactive Unit—Study of Morphological Features with Clinical Correlation

Utility of Direct Immunofluorescence in Cutaneous Autoimmune Bullous Disorders

A clinicopathological and immunofluorescence study of intraepidermal immunobullous diseases

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