Direct immunofluorescence in autoimmune vesiculobullous disorders: A study of 59 cases

Background: The autoimmune bullous diseases are characterized by pathogenic autoantibodies directed at target antigens whose function is either cell-cell adhesion within the epidermis or adhesion of stratified squamous epithelium to dermis or mesenchyme. Aim: To assess the correlation between clinical, histopathological and direct immunofluorescence patterns in autoimmune vesiculobullous diseases and to assess the diagnostic value of direct immunofluorescence in various autoimmune vesiculobullous diseases. Materials and Methods: The study was conducted for a period of 24 months from August 2006 to August 2008. Total of 59 patients aged 3-80 years with vesiculobullous lesions of both sexes attending the department of dermatology were selected for the study. These samples were tested and analyzed under light microscope and direct immunofluorescence (DIF) testing. Results: Among the patients of vesiculobullous disorders studied most common disorder was found to be pemphigus vulgaris, constituting 40.6% cases. About 43.5% of patients presented with flaccid vesicles and bullae. Around 26.4% of the patients presented with tense bullae. Mucosal involvement was found in 57.6% of cases. Tzanck smear was positive for acantholytic cells in 54.2% of cases. Bullae were located sub epidermally in 30.5% of the patients, for 54.2% of patients they were located intra epidermally and no bullae were seen in 15.25% of cases. DIF was positive in 93.2% cases of autoimmune vesiculobullous disorders. Out of 59 cases of autoimmune vesiculobullous disorders, only 41 (69.4%) cases correlated clinically and histopathologically with direct immunofluorescence patterns. Conclusion: Our study proves DIF is not only diagnostic but also confirmatory for all autoimmune bullous disorders.