A One Year Cross-Sectional Clinico-Histopathological and Immunofluorescence Study of Autoimmune Vesiculobullous Disorders in Patients Attending K.L.E.S Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum

Abstract

Background and objectives: The aim of the study was to study the various clinical features, histopathological findings and direct immunofluorescence findings in patients with autoimmune vesiculobullous disorders. Materials and methods: The present study was a one-year cross sectional study from November 2007 to December 2008. All new clinically diagnosed cases of autoimmune vesiculobullous disorders were included in the study. The patient's demographic data, age of onset, duration of disease, symptoms, location and types of lesions and associated systemic diseases were noted in a pre- tested and pre-designed proforma. Routine investigations, Tzanck smear ( cytology ) , skin biopsy and direct immunofluorescence were done in all the patients after informed consent and counseling. Results: A total number of 20 cases were studied. The incidence of autoimmune vesiculobullous disorders in our hospital was 0.11%. Pemphigus vulgaris constituted the most common type ( 55% ) , followed by bullous pemphigoid ( 20% ) . Pemphigus was most common in the 5 th decade and bullous pemphigoid in the 7 decade. The sex ratio of the study population was 1:1. Pemphigus vulgaris and pemphigus foliaceous showed female predominance while bullous pemphigoid and chronic bullous disease of childhood showed male predominance. Trunk was the most common site involved. All pemphigus patients had flaccid blisters, while all patients with bullous pemphigoid and chronic bullous disease of childhood had tense blisters. Oral mucosa was involved in pemphigus vulgaris ( 90.9% ) and bullous pemphigoid ( 50% ) . Nikolsky sign, Bulla spread sign and Tzanck smear for acantholytic cells were positive in all pemphigus patients. Histopathology showed suprabasal blisers in all pemphigus vulgaris cases, subcorneal blisters in all pemphigus foliaceous cases and subepidermal blisters in all cases of bullous pemphigoid and chronic bullous disease of childhood. DIF was positive in all the cases. Conclusion: Clinical examination and cytology are helpful in making a provisional diagnosis in autoimmune vesiculobullous disorders. Histopathological examination and direct immunofluorescence are required for making a definitive diagnosis. Direct immunofluorescence is helpful in confirming the diagnosis. It is however not a substitute for histopathology, but rather complementary to it.