Direct Immunofluorescence study of Immunobullous Disorders

Ajith Kumar, L B (2020) Direct Immunofluorescence study of Immunobullous Disorders. Masters thesis, Madras Medical College, Chennai.


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BACKGROUND: Autoimmune bullous disorders are rare dermatological disorders, ranging in incidence from 0.5 – 3.2 cases/1,00,000/year. Due to their rarity and polymorphic presentation, these disorders pose a diagnostic challenge, hence it is essential to establish the diagnosis rapidly and accurately to plan adequate treatment. Autoimmune blistering diseases are due to autoimmune response against structural proteins of skin mediating cell to cell and matrix adhesion. OBJECTIVES: 1. To study the epidemiological spectrum of various immunobullous disorders. 2. To determine the efficacy of direct immunofluorescence in terms of rapidity, reliability and accurate diagnosis of immunobullous disorders. 3. To determine the clinicopathological correlation in immunobullous disorders. METHODOLOGY: This is a descriptive study conducted from February 2018 to January 2019 at the Department of Dermatology, Madras Medical college and Rajiv Gandhi Government General Hospital, Chennai. Seventy consecutive patients who presented with clinical evidence of immunobullous disorder such as bulla, vesicle, erosions, mucosal erosions , vegetative lesions were included in the study. All the patients were explained about the study in detail, and after getting a proper informed written consent in local language and included in the study. Inclusion criteria: 1. Both male and female patients with clinical evidence of bulla or vesicle suspected to be immunobullous disorder of age group (13 to 80 years). 2. Patients who are willing to give consent to participate in the study. Exclusion criteria: 1. Both male and female patients who are already a known case of immunobullous disorder on treatment. 2. Pregnant and lactating women with clinical evidence of immunobullous disorder. 3. All patients of age group less than 13 and greater than 80 years of age with clinical suspicion of immunobullous disorder. 4. Patients not giving consent to participate in the study. A detailed case history of each patient was recorded with reference to name, age, sex, address, contact number, op number and inpatient number, occupation, presenting complaints with duration, presence of other associated symptoms, treatment history (both topical and systemic) was taken. Head to foot dermatological examination was done and all clinical features such as vesicle, bulla and other morphological lesions, extent of involvement, mucosal(oral,genital and conjuctial) involvement, involvement of hair, nail, scalp were recorded. Bedside investigations such as Tzanck test for acantholytic cells, Nikolsky sign, Bulla spread sign were done. Blood investigations such as complete blood count, renal function test, liver function test, bleeding time, clotting time, VCTC, VDRL were done. Two separate samples were taken from the patient, one from a newly formed bulla or vesicle for haematoxylin and eosin stain and the other sample from a perilesional normal looking skin for direct immunofluorescence study. The results were interpreted and recorded in the proforma. All patients participating in the study were given appropriate treatment with topical and systemic therapy and periodic follow up was done. RESULTS: Our study included 70 patients which included 36 males and 34 females. The youngest patient among the study group was 14 years and the eldest being 80. The duration of illness was more common between 1 to 3 months. The most common comorbidity associated with was diabetes mellitus. Pemphigus vulgaris was the most common autoimmune bullous disorder. Diagnosis by Direct immunofluorescence testing was more rapid – results were obtained within two days. Direct immunofluorescence was positive in 60 (85.71%) patients. DIF testing along with clinical and histopathological findings was reliable in arriving at a reliable diagnosis in 95.71% of patients. CONCLUSION: Immunobullous disorders are a diverse group of disorders. Proper diagnosis depends on a stepwise diagnosis and a combination of clinical, bedside investigations, histopathological and Direct immunofluorescence testing.

Item Type: Thesis (Masters)
Additional Information: 201730002
Uncontrolled Keywords: Immunobullous disorders, Direct immunofluorescence , bulla, vesicle.
Subjects: MEDICAL > Dermatology Venereology and Leprosy
Depositing User: Subramani R
Date Deposited: 05 Feb 2021 01:03
Last Modified: 05 Feb 2021 01:03

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