Direct Immunofluorescence in Immunobullous disorders of skin with histopathological correlation.

Ram Ganesh, V R (2010) Direct Immunofluorescence in Immunobullous disorders of skin with histopathological correlation. Masters thesis, PSG Institute of Medical Sciences & Research, Coimbatore.


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There has been great progress during the past 5 decades in our understanding of the biology of the skin as it relates to the bullous diseases. One of the main reasons for continued identification of new bullous diseases is because diagnosis is based on immunological and molecular basis in addition to clinical and histological findings. The stratified squamous epithelium of the human epidermis forms a continuous barrier against the external environment. The pathophysiology of bullous diseases illustrates how impairments in epithelial adhesion lead to disorders characterized by substantial morbidity and/or mortality. Blistering diseases can be inherited or acquired; most examples of the latter are autoimmune in nature and are characterized by autoantibodies that target junctional molecules promoting either cell-cell or cellmatrix adhesion in skin. This latter group together constitutes the spectrum of immunobullous disorders. The pemphigus group of diseases is associated with antibodies to desmosomal proteins. The autoantibody in each type of pemphigus is directed against a unique desmososmal protein or a combination of desmosomal proteins. The subepidermal bullous diseases are associated with antibodies against one or more components of the Basement Membrane Zone (BMZ). The diagnostic specificities of the clinical and histopathological findings vary among the bullous diseases with significant overlap between the various entities. The commonly used modalities for the diagnosis of immunobullous disorders are histopathology and immunofluorescence (both Direct and Indirect). In addition, higher centres employ techniques such as ELISA, immunoblotting and immunoelectron microscopy which give highly accurate results (used more often for research). Direct Immunofluoresence(DIF) helps detect molecules such as antibodies and complement components within biopsy specimens taken from perilesional skin The proportion of immunobullous diseases out of the total number of skin biopsies received by our institution over a period of two years was 82. Of these 82 cases, we included only those cases for which both direct immunofluorescence and histopathology had been done (total 40 cases). The remaining 42 cases had either only histopathology or immunofluorescence done and hence were not included. The correlation between histopathology and DIF was high in our study and comparable to previous studies20, 30, but the study is limited by the fact that our sample size was small. There were two false negative cases (both patients had clinically active disease) which could have probably been due to technical or sampling errors.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Direct Immunofluorescence; Immunobullous disorders of Skin; Histopathological correlation.
Subjects: MEDICAL > Pathology
Depositing User: Subramani R
Date Deposited: 21 Jun 2017 11:39
Last Modified: 22 Jun 2017 05:55

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