Correlation of Histology of Vesiculobullous Disorders With Immunofluorescence: A Study at A Tertiary Care Centre

Introduction: Vesiculobullous disorders present with varied clinical manifestations. Vesicles and bullae are fluid filled cavities present within or beneath the epidermis. They are autoimmune blistering disorders in which autoantibodies are directed against target antigens present in the epidermis and dermoepidermal junction. Aim: To study and analyse the clinical, histopathological and immunofluorescence findings in bullous lesions of the skin and to determine the contribution of immunofluorescence in diagnosing these conditions when there is a histological overlap. Materials and Methods: A total of 50 cases were selected in a two years span. Punch biopsy specimens of the skin taken from early lesions, sent for histopathological examination and Direct Immunofluorescence (DIF), were processed routinely. The light microscopic and immunofluorescence stained slides were studied and correlated with the clinical findings. Results: Pemphigus vulgaris was the most common vesiculobullous disorder (36%) followed by bullous pemphigoid (28%), pemphigus foliaceus (10%),hailey-hailey disease (8%), dermatitis herpetiformis (8%) and others (10%). Conclusion: The present study concludes that all the patients of vesiculobullous disorder may not present clinically with classical morphological features. In such conditions where clinical diagnosis is a problem, biopsy from the lesion helps in arriving at the final diagnosis. In cases where histopathological findings are not typical, DIF helps to diagnose the disease which shows typical pattern of immune deposition at the appropriate site. So, a separate specimen should be submitted for DIF. In order to make a final diagnosis, it is important to correlate the clinical details, history of prior treatment, histomorphological and DIF findings.