Direct immunofluorescence study of 25 cases of subepidermal blisters.

Vijay, Singhal (2009) Direct immunofluorescence study of 25 cases of subepidermal blisters. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION : Several skin diseases are characterized by the presence of blisters. In some, this may be the only morphologic clue to the diagnosis, whereas in other disease, blisters may be one of the several manifestations. The immunobullous disorders are a group of autoimmune diseases in which components of the epidermis and basement membrane zone are the focus of attack, resulting in the formation of cutaneous and mucosal blisters. The autoimmune bullous diseases result from an immune response to molecular components of intercellular adhesion molecules in desmosomes or the basement membrane zone (BMZ). The diagnosis of autoimmune bullous diseases is based on the evaluation of clinical findings, histopathology, direct immunofluorescence (DIF), and indirect immunofluorescence (IIF). The autoimmune blistering diseases may be subdivided into intraepidermal (pemphigus) and subepidermal (pemphigoid) blistering disorders on the basis of the level at which blistering occurs. Prior to the early 1950s, most generalized bullous diseases were considered to be variants of pemphigus, regardless of the level of skin cleavage or differences in clinical appearance or course. Pemphigus and pemphigoid, the two most common autoimmune bullous disorders, were first well separated by Lever in the early 1950s With the development and application of immunofluorescence microscopy in the mid 1960s further distinctions were made not only between pemphigus and pemphigoid but among other autoimmune diseases also. Immunofluorescence testing is of utmost value in confirming a diagnosis that is suspected by clinical or histologic examination. This is especially true in subepidermal bullous diseases that often have overlap in the clinical and histologic findings. AIM OF THE STUDY : 1. To find out the incidence of various subepidermal bullous disorders 2. To study the age wise distribution 3. To study the sex distribution 4. To study the disease association 5. To study the immunoreactant pattern of subepidermal blisters on direct immunofluorescence. CONCLUSION : 1. Bullous pemphigoid was the most common subepidermal blistering disease. 2. Bullous pemphigoid was twice as common in males as in females. 3. Rare association of cystic disease of various organs was noted with bullous pemphigoid group of patients. 4. Linear pattern deposition of C3 at BMZ was seen in 17 patients and granular pattern in one patient. 5. Colloid bodies were also seen in one BP patient, they are not specific for any disease. 6. Deposition of IgM and fibrinogen, apart from other immunoreactants were seen in bullous pemphigoid patient. 7. Linear IgA patient showed linear IgA deposition at BMZ. 8. In CBDC patient IgA, IgG, IgM, C3 and fibrinogen deposition was seen. 9. Multiple immunoreactant deposition was seen in bullous SLE patient. 10. In bullous SLE, immunoreactant deposition was seen in both granular and linear patterns. 11. Lichen planus pemphigoides patient showed IgG and C3 deposition at BMZ and few colloid bodies stained with IgM and IgA. 12. Bullous lichen planus patient showed colloid bodies stained by IgM, IgG, IgA and C3. Strong ragged fibrinogen band was seen at BMZ. 13. Pemphigoid vegetans patient showed C3, IgG, IgA and fibrinogen deposition at BMZ.

Item Type: Thesis (Masters)
Uncontrolled Keywords: subepidermal blisters ; Direct immunofluorescence study.
Subjects: MEDICAL > Dermatology Venereology & Leprosy
Depositing User: Subramani R
Date Deposited: 05 Jul 2017 04:17
Last Modified: 05 Jul 2017 08:57

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