Clinicopathological and immunofluorescence study of vesiculobullous disorders

Abstract

Background: Vesiculobullous diseases are mostly immune mediated and diagnosed based on the clinical features, histology and Immunofluorescence. The aim of the study was to identify the immunofluorescence pattern in auto immune vesiculobullous diseases and correlate it with the clinical profile and histology.

Methods: Patients attending the dermatology outpatient department in a tertiary hospital with vesiculobullous diseases, suggestive of auto immune aetiology were evaluated clinically. Histopathology and direct immuno-fluorescence were done in all patients.

Results: During the one year period from June 2008 to July 2009, 40 patients with vesiculobullous disorders clinically suggestive of auto immune aetiology attended the outpatient department. Out of the 40 patients, 22 (55%) patients were diagnosed to have intraepidermal with female preponderance and 18 patients (45%) sub epidermal blistering diseases. Bullous pemphigoid was the commonest sub epidermal disease, seen in 8 patients.

Conclusions: In all cases diagnosed clinically as pemphigus a histological diagnosis of pemphigus was made (100%). The clinical variants of pemphigus could also be diagnosed in all cases histologically (100%). The positive and negative predictive value was 100% in pemphigus group cases. Histology of all patients showed subepidermal bulla (100%). A specific diagnosis could be made in 18 patients with sub epidermal disease (100%). DIF was found to be an invaluable tool in diagnosing different diseases belonging to the sub epidermal group, but it was not of much help in sub classifying variants of pemphigus.