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. Methods: A cross-sectional study of 68 patients to evaluate the clinical, histopathological and direct immunofluorescence (DIF) features in the diagnosis of cutaneous vesiculobullous disorders. The patients with vesiculobullous lesions were subjected to clinical examination regarding socio-demographic and clinical data. Two biopsy specimens were taken, one from intact vesicle for histopathological study and another from perilesional normal looking skin or oral mucosa for DIF. Results: Vesiculobullous lesions constituted 22.08% of total number of skin biopsies. The most common clinical diagnosis was pemphigus vulgaris (PV) in 36 cases, followed by bullous pemphigoid (BP) in 8 cases, pemphigus foliaceous (PF) in 6 cases, and dermatitis herpetiformis (DH) in 4 cases. Characteristic histopathological features were present in 26 cases of PV, 9 cases of BP and 4 cases of PF, and 17.7% showed non- specific changes. DIF was positive in 24 cases of PV, 9 cases of BP and 3 cases of PF, and negative in 34.92% of cases. Conclusion: Clinical, histopathological and DIF features together or in combination help in the final diagnosis of vesiculobullous disorders. Individually, none of these methods are diagnostic in each and every case.

Keywords

• vesiculobullous disorders
• pemphigus
• bullous pemphigoid
• direct immunofluorescence