Diagnostic procedures for autoimmune vesiculobullous diseases: A review

Abstract

Oral soft tissues are affected by numerous pathologic conditions of variable etiology and hence their appropriate management relies on their accurate diagnosis. Clinical identification of intact vesicle and bulla in the oral cavity is really a challenge due to the regular irritation and the friable nature of oral mucosa. Rupture of these lesions leads to erosions or ulcerations on the surface, hence making the diagnosis of vesiculobullous (VB) lesions is even more difficult due to the fact that the differential diagnosis along with VB lesions will also include ulcerative, immunological-mediated diseases, and neoplasms and systemic diseases. Hence, knowledge of the clinical presentation of these disorders and the relevant diagnostic procedures is important not just for dermatologists, but also for general practitioners and dentists. In this article, the various procedures have been explained that can be used for the diagnostic purpose of VB lesions.

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

“…Various diseases along with its manifestations can commonly involve the skin and mucous membranes out of which vesiculobullous lesions form a predominant group [12] . Although vesicles and bullae occur in several nonspecific conditions there exists a group of disorders in which blisters are the primary and most distinctive feature of presentation.These bullous diseases, in some instances are fatal if untreated [13] . Blisters occur at different levels within the skin in the various disorders and histologic assessment is essential for accurate diagnosis providing insight into the pathogenic mechanisms.…”

“…The main function of our immune system is to protect an individual from foreign or non-self-antigens without reacting with self-antigens. Sometimes this is distorted and leads to auto immune disorders [13] . Vesiculobullous lesions are mostly immune mediated, and the immunopathogenesis is specific for each disease, which is of diagnostic importance.…”

What is the optimal site and biopsy technique for the diagnosis of oral mucosal autoimmune blistering disease?

“…[9][10][11][12][13][14][15] A fresh oral vesicle or bulla with perilesional tissue is optimal, but these do not survive long in the oral environment and are rarely available for biopsy. 1 If the lesion has a hyperkeratotic component, this should be included in the sample. 3 Gingival biopsies in particular are prone to tearing during surgical manipulation even if not affected by an AIBD but, as was the case in our sample, desquamative gingivitis is very common in AIBDs and in half of the cases is the only site of involvement.…”

“…For prompt, definitive diagnosis and appropriate subsequent management of AIBDs thorough clinical history and examination, followed by laboratory investigation, are required. The latter include histopathology and more complex, expensive and time‐consuming techniques such as immunoprecipitation, Western blot and enzyme‐linked immunosorbent assay (ELISA) . Despite advances in molecular methods, an adequate biopsy for histopathological examination and immunofluorescence (IF) remains the most common means by which to reach the diagnosis.…”

“…The latter include histopathology and more complex, expensive and time-consuming techniques such as immunoprecipitation, Western blot and enzymelinked immunosorbent assay (ELISA). 1 Despite advances in molecular methods, an adequate biopsy for histopathological examination and immunofluorescence (IF) remains the most common means by which to reach the diagnosis. Routine tissue fixation and histopathological processing will in most cases provide the basis for the definitive IF study, which is the "gold standard."…”