Turkish Journal of Pathology

Türk Patoloji Dergisi

Turkish Journal of Pathology

Turkish Journal of Pathology

2012, Vol 28, Num, 1     (Pages: 011-016)

Evaluation of Clinical and Histopathologic/Direct Immunofluorescence Diagnosis in Autoimmune Vesiculobullous Dermatitis: Utility of Direct Immunofluorescence

Banu LEBE 1, Gülen GÜL NİFLİOĞLU 1, Selen SEYREK 1, Hülya ELLİDOKUZ 2

1 Department of Pathology, Dokuz Eylül University, Faculty of Medicine, İZMİR, TURKEY
2 Department of Biostatistics and Medical Informatics, Dokuz Eylül University, Faculty of Medicine, İZMİR, TURKEY

DOI: 10.5146/tjpath.2012.01091
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Objective: Autoimmune bullous diseases are heterogeneous diseases and the differentiation between the various bullous disease is important for treatment and prognosis. Direct immunofluorescence microscopy is still the gold standard in differentiating these diseases. Our aim was to determine the diagnostic accordance between clinical and histopathological/direct immunofluorescence diagnosis of patients with autoimmune vesicolulobullous skin diseases.

Material and Method: A total of 197 cases with clinical diagnosis of vesiculobullous dermatitis was included in the study. The slides stained with H&E were retrospectively re-evaluated for histopathological diagnosis, and had already been evaluated with direct immunofluorescence microscopy. Data were analyzed using the Scientific Package for Social Sciences software. Results were evaluated using Kappa statistics.

Results: The clinical and histopathological/direct immunofluorescence accordance for cases ranged from 0% to 100% (Kappa value=0.29). The accordance was 58.8% in pemphigus vulgaris, 53.8% in pemphigus foliaceus, 37.9% in bullous pemphigoid and, 5.2% in dermatitis herpetiformis. Cases of limited numbers in our study were linear IgA bullous dermatitis in 2 cases, Grover's disease in 1 case, epidermolysis bullosa acquisata in 5 cases and, Hailey-Hailey disease in 1 case. The percentages of accordance in these cases were 50%, 100%, 40% and, 0%, respectively.

Conclusion: The accordance was good in pemphigus vulgaris, pemphigus foliaceus and bullous pemphigoid, but low in dermatitis herpetiformis. Based on our results, we recommend direct immunofluorescence microscopy to be added to light microscopy for the definitive diagnosis of autoimmune blistering disease. Only light microscopic findings are not sufficient and direct immunofluorescence microscopy is the gold standard.

Keywords : Fluorescent antibody technique, Direct, Vesiculobullous skin diseases