Clinicopathological Spectrum of Vesiculobullous Skin Lesions with Special Reference to Direct Immunofluorescence Microscopy
Introduction: Accurate diagnosis of vesiculobullous lesions of skin requires evaluation of clinical, histopathological, and immunofluorescence findings. Materials and methods: A clinicopathological study of vesiculobullous lesions of skin was carried out over a period of 2 years in a tertiary hospital, Navi Mumbai, India. Forty-one cases of vesiculobullous disease were reported. Patients were evaluated based on their clinical findings, histopathological, and direct immunofluorescence (DIF) features to arrive at a definitive diagnosis in case of cutaneous vesiculobullous diseases. Biopsies comprised lesional as well as perilesional skin. Results: Majority of the patients (34.15%) were in the age group of 40 to 49 years. Male to female ratio was 1:1.4. All the cases presented with blister. Pemphigus vulgaris (PV) was the most common vesiculobullous disease accounting for 39.02% followed by bullous pemphigoid (BP) in 29.27%. Pemphigus foliaceus (PF) and Hailey-Hailey disease (HDD) constituted 7.32% each. 4.88% cases were of spongiotic dermatitis, while one case each of Pemphigus erythematous (PE), subcorneal pustular dermatoses (SCPD), epidermolysis bullosa acquisita (EBA), lichen planus pemphigoid (LPP), and bullous lichen planus (BLP) accounting for 2.44%. Histopathological features were conclusive in 85.37% cases. Direct immunofluorescence was contributory in 14.63% cases, where histopathology was inconclusive. Conclusion: Histopathology was important for differentiating PV from PF. A good clinicopathological correlation was seen. Thus, correlation of clinical, histopathological, and DIF required for definitive diagnosis of vesiculobullous lesions of the skin.