Abstract

Clinicopathological study of vesiculobullous diseases with special emphasis on autoimmune disorders-two year study in a resource setting

Objective: To identify the characteristic histopathologic findings and analyse the diagnostic concordance between clinical and histopathological diagnosis of patients with vesiculobullous diseases. Methods: This was a two-year descriptive study conducted in the Department of Pathology where all skin biopsies diagnosed as vesiculobullous diseases were included. A detailed history and relevant clinical examination findings were documented. The specimens were formalin-fixed, paraffin-embedded and stained with haematoxylin and eosin. Direct immunofluorescence was advised for patients where histopathologic features were inconclusive. Results: There were 111 skin biopsy specimens included in the study. Demographic details showed female predominance (65.8%) and the most frequent age group being (40-69) years (29%). Generalised distribution of the lesions over the trunk (53%) associated with itching was the common clinical manifestation. Most frequent clinical diagnosis in the study was pemphigus vulgaris (38%) and bullous pemphigoid (31%). Histopathologic findings revealed subepidermal blister (52.3%) as the most common finding. Inflammatory cell infiltrates constituted the main content of the blister (44.1%) with eosinophils being the predominant cell type (37.8%). There was a good positive correlation of 0.546 between histopathologic and clinical diagnosis. Conclusion: Bullous pemphigoid constituted the most common vesiculobullous disease followed by pemphigus vulgaris in this study. Histopathological diagnosis correlated well with clinical diagnosis in most of the vesiculobullous disease, emphasizing the need for skin biopsy in all cases of vesiculobullous diseases. Direct Immunofluorescence is a helpful adjunct in scenarios where clinical and/ or histopathological features are inconclusive.

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