Evaluation of clinical and histopathologic/direct immunofluorescence diagnosis in autoimmune vesiculobullous dermatitis: utility of direct immunofluorescence.
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.


METHODS
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.


CONCLUSIONS
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.
Department of Pathology, Dokuz Eylül University, Faculty of Medicine, İzmir, Turkey. banu.lebe@deu.edu.tr
Banu
B
Lebe
Gülen
G
Gül Nıflıoğlu
Selen
S
Seyrek
Hülya
H
Ellıdokuz
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D019085:Fluorescent Antibody Technique, Direct; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012872:Skin Diseases, Vesiculobullous / Q000175:diagnosis*; D055815:Young Adult