Evaluation of clinical and histopathologic/direct immunofluorescence diagnosis in autoimmune vesiculobullous dermatitis: Utility of direct immunofluorescence

Abstract

Objective: Autoimmune bullous diseases are heterogeneous diseases and the diferentiation between the various bullous disease is important for treatment and prognosis. Direct immunofuorescence microscopy is still the gold standard in diferentiating these diseases. Our aim was to determine the diagnostic accordance between clinical and histopathological/direct immunofuorescence diagnosis of patients with autoimmune vesicolulobullous skin diseases. Material and Method: A total of 197 cases with clinical diagnosis of vesiculobullous dermatitis was included in the study. Te slides stained with H&E were retrospectively re-evaluated for histopathological diagnosis, and had already been evaluated with direct immunofuorescence microscopy. Data were analyzed using the Scientific Package for Social Sciences sofware. Results were evaluated using Kappa statistics. Results: Te clinical and histopathological/direct immunofuorescence accordance for cases ranged from 0% to 100% (Kappa value=0.29). Te accordance was 58.8% in pemphigus vulgaris, 53.8% in pemphigus foliaceus, 37.9% in bullous pemphigoid and, 5.2% in dermatitis herpetiformis. Cases of limited numbers in our study were linear IgA bullous dermatitis in 2 cases, Grover's disease in 1 case, epidermolysis bullosa acquisata in 5 cases and, Hailey-Hailey disease in 1 case. Te percentages of accordance in these cases were 50%, 100%, 40% and, 0%, respectively. Conclusion: Te accordance was good in pemphigus vulgaris, pemphigus foliaceus and bullous pemphigoid, but low in dermatitis herpetiformis. Based on our results, we recommend direct immunofuorescence microscopy to be added to light microscopy for the definitive diagnosis of autoimmune blistering disease. Only light microscopic findings are not suficient and direct immunofuorescence microscopy is the gold standard.