title: Clinical, demographic and immunopathological spectrum of subepidermal autoimmune bullous diseases at a tertiary center: A 1-year audit.
abstract: BACKGROUND
  The subepidermal autoimmune bullous diseases are a subset of immunobullous diseases encountered less frequently in the Indian population. There is a paucity of data on the prevalence, demographic and clinicopathological spectrum of various subepidermal autoimmune bullous diseases from India.
  
  
  OBJECTIVE
  To determine the demographic and clinicopathological profile of subepidermal autoimmune bullous diseases in Indian patients, presenting to the Immunobullous Disease Clinic of Postgraduate Institute of Medical Education and Research, Chandigarh.
  
  
  METHODS
  Patients seen from November 2013 to November 2014 who fulfilled the preset diagnostic criteria of subepidermal autoimmune bullous diseases were identified from case records. Data regarding demographic characteristics, clinical profile, immunopathological findings and treatment were collected from the predesigned proforma.
  
  
  RESULTS
  Of 268 cases of autoimmune bullous diseases registered, 50 (18.7%) were subepidermal autoimmune bullous diseases. Bullous pemphigoid was most frequently seen in 20 (40%) cases, followed by dermatitis herpetiformis in 14 (28%), mucous membrane pemphigoid in 6 (12%), chronic bullous dermatosis of childhood / linear immunoglobulin A bullous dermatosis in 5 (10%), lichen planus pemphigoides in 3 (6%), pemphigoid gestationis and epidermolysis bullosa acquisita in 1 (2%) case each. None of the patients had bullous systemic lupus erythematosus.
  
  
  CONCLUSIONS
  We could not perform direct and indirect immunofluorescence using salt-split skin as a substrate and immunoblotting due to non-availability of these facilities. Therefore, misclassification of subepidermal autoimmune bullous diseases in some cases cannot be confidently excluded.
  
  
  CONCLUSIONS
  Subepidermal autoimmune bullous diseases are not uncommon in Indian patients. Bullous pemphigoid contributes maximally to the burden of subepidermal autoimmune bullous diseases in India, similar to that in the West, although the proportion is lower and disease onset is earlier. Dermatitis herpetiformis was observed to have a higher prevalence in our population, compared to that in the West and the Far East countries. The prevalence of other subepidermal autoimmune bullous diseases is relatively low. Detailed immunofluorescence and immunoblotting studies on larger patient numbers would help better characterize the pattern of subepidermal autoimmune bullous diseases and their features in Indian patients.
authors.forename: Dipankar
authors.initials: D
authors.lastname: De
authors.forename: Geeti
authors.initials: G
authors.lastname: Khullar
authors.affiliation: Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Handa
authors.forename: Uma Nahar
authors.initials: UN
authors.lastname: Saikia
authors.forename: Bishan Das
authors.initials: BD
authors.lastname: Radotra
authors.forename: Biman
authors.initials: B
authors.lastname: Saikia
authors.forename: Ranjana W
authors.initials: RW
authors.lastname: Minz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001327:Autoimmune Diseases / Q000175:diagnosis* / Q000453:epidemiology* / Q000276:immunology; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit / Q000379:methods; D008875:Middle Aged; D012872:Skin Diseases, Vesiculobullous / Q000175:diagnosis* / Q000453:epidemiology* / Q000276:immunology; D062606:Tertiary Care Centers; D055815:Young Adult