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(searched for: doi:10.18203/issn.2455-4529.intjresdermatol20173203)
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Maryam Khalili, Simin Shamsi Meymandi, Rezvan Amiri, Mahin Aflatoonian, Fatemeh Ghayoori, Niloofar Mehrolhasani
Published: 30 September 2022
Journal of Skin and Stem Cell, Volume 9; https://doi.org/10.5812/jssc-129556

Abstract:
Background: Bullous diseases are classified as autoimmune blistering diseases, hereditary blistering disorders, and blistering diseases secondary to inflammation and physical trauma. This study evaluated clinicopathological features of patients with bullous diseases. Methods: This is a retrospective cross-sectional study of 88 patients with vesiculobullous diseases referred to the dermatology clinic of Afzalipour hospital in Kerman, Iran. Demographic features of the patients, type of lesions, differential diagnosis, and pathological features (site of skin biopsy, final pathological diagnosis, type of inflammatory cells, and direct immunofluorescence results) were recorded. Data were analyzed by chi-square test and independent t-test. Results: Eighty-eight patients (59.1% females and 40.9% males) were evaluated. The mean age of patients was 45.09 ± 20.48 years. Autoimmune blistering diseases, hereditary bullous diseases, and blisters secondary to inflammation and trauma were observed in 79.5%, 11.4%, 6.8%, and 2.3% of the cases, respectively. The most common diseases were pemphigus vulgaris (29.5%) and bullous pemphigoid (21.6%). There was a significant correlation between the type of the disease and the age of patients (P-value = 0.001) and the duration of the disease (0.047). Conclusions: The most common autoimmune blistering diseases, hereditary bullous diseases, and blisters secondary to inflammation and trauma were pemphigus vulgaris, epidermolysis bullosa, lichen planus, and diabetic bullae/friction blister, respectively.
Arika Brar, Abhimanyu Sharma, , , , , Kusum Joshi
Published: 19 April 2021
Journal: Cureus
Abstract:
Autoimmune bullous disorders (AIBD) are a heterogeneous group of disorders with substantial clinical overlap associated with blistering of skin or mucosa. The present study aimed to study the histopathological spectrum and evaluate the utility of direct immunofluorescence (DIF) on snap-frozen and paraffin-embedded sections in resolving the differential diagnosis of AIBD and connective tissue disorders of the skin. We also compared the efficacy of DIF on paraffin versus the snap-frozen sections in diagnosing AIBD. The present study was conducted for three years (2017-2019) and included 27 biopsies. We also included a retrospective analysis that included 25 biopsies collected over three years (2014-2017). Histopathological examination and DIF were conducted on all samples. Pemphigus vulgaris was the most common autoimmune cutaneous disorder constituting 37% (n = 10) in prospective and 36% (n = 9) in the retrospective study. DIF showed a specificity of 81.25% in our prospective study. While on the paraffin-embedded sections, it showed a specificity of 66.6% in our retrospective study. In the prospective study, DIF on paraffin-embedded sections had a positivity rate of 43.75% as compared to 81.25% in DIF done on snap-frozen sections. DIF is a sensitive tool for the diagnosis as well as distinguishing immune-mediated bullous disorders from other lesions primarily when performed on snap-frozen sections. The diagnostic yield is enhanced by DIF in cases that pose a diagnostic dilemma both clinically and histologically. The final diagnosis depends on all clinical, histopathological and immunofluorescence findings.
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