A Study of Vesiculobullous Lesions of Skin

Introduction: Bullous dermatoses are a wide variety of blistering diseases some of which can be extremely debilitating and even fatal. This study shows the importance of histopathology over immunofluorescence studies in the diagnosis of the same. Aim: To analyse the histopathological patterns of non infectious vesiculobullous lesions seen in patients attending Dermatology Department of Kottayam Medical College, for a period of 2 years. Also to correlate the histopathology and immunofluorescence diagnosis in auto immune blistering diseases. Materials and Methods: Skin biopsies of 100 clinically diagnosed vesiculobullous cases were processed and paraffin embedded. Histologic examination of the H&E stained sections of the same were done. The level of split of lesions, mechanism of blistering and nature of infiltrate noted. Meanwhile perilesional skin of the suspected autoimmune diseases were sent in Michel’s medium for immunofluorescence study and their patterns correlated with histological diagnosis. Results: Of the 100 cases studied, autoimmune blistering diseases comprised the major portion of cases. Pemphigus vulgaris headed the list among all the individual lesions, second being bullous pemphigoid. Among all, histopathological diagnosis correlated with clinical diagnosis in 87% cases. Of all the IF proven cases, histopathological diagnosis correlated with immunofluorescence in 77.77% cases. The positive predictive value of histopathological examination in diagnosing pemphigus group of diseases which are proven by immunofluorecence was 93.75%, sensitivity was 90.09%. The positive predictive value of histopathological examination in diagnosing bullous pemphigoid lesions which are proven by immunofluorecence was 93.33%, sensitivity was 77.77%. Conclusion: This study emphazises that morphological diagnosis by histopathology is as good as immunoflourescence in the diagnosis of vesiculobullous lesions and shows the diversity of histomorphological patterns in the various blistering diseases encountered. The systematic approach to the histopathological sections could help in correct diagnosis at the earliest