1 Year Cross-Sectional Study Of Direct Immunofluorescence In The Diagnosis Of Immunobullous Disorders

Abstract

Objectives: The aim of the study is to study the clinical, histopathological and direct immunofluorescence features and to evaluate the sensitivity of direct immunofluorescence in diagnosis of autoimmune vesiculobullous disorders. Materials and methods: The present study was a one-year cross sectional study from January 2017 to December 2017. Newly diagnosed cases of autoimmune vesiculobullous disorders were included in the study. The patient’s demographic data, age of onset, duration of disease, symptoms, types and distribution of lesions and other diseases were noted in a pre-designed proforma. Routine investigations, bedside Tzanck smear and two specimens of skin biopsy, a lesional specimen for histopathology and a perilesional specimen of direct immunofluorescence were done in all patients after informed consent was taken. Results: In the present study, pemphigus vulgaris consisted of the most common vesiculobullous disorder composing 50% of the study group followed by 35% by bullous pemphigoid, 10% by pemphigus foliaceus and 5% by chronic bullous disease of childhood. Most of the cases presented in age group of 41-60 years with a female preponderance. All of the cases of pemphigus vulgaris showed suprabasal clefting with acantholytic cells. 1 of the 2 cases of pemphigus foliaceus showed subcorneal cleft. 4 of the 7 cases of bullous pemphigoid and the only CBDC case showed cleft at dermo-epidermal junction. 100% of cases showed positive findings on DIF. In 4 cases out of 20, HPE findings were discordant with clinical and DIF findings. Conclusion: Clinical and histopathological findings have to be correlated with DIF findings to reach a definitive diagnosis and hence direct immunofluorescence is a gold standard for the diagnosis of autoimmune vesiculobullous disorders.