Shoaib Raza Rizvi, Saleem Sadiq.
Use of direct immunofluorescent microscopy in the diagnosis of vesiculobullous disorders of skin.
Pak J Med Sci May ;26(2):411-5.

Objective: To determine the relative frequencies of various vesiculobullous disorders of skin in our patients and the morphological and direct immunofluorescent patterns of these disorders. Methodology: This retrospective study was carried out in the Department of Pathology, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi, Pakistan on all the cases of vesiculobullous disorders of skin diagnosed in the department from January 2002 to June 2007. All the skin biopsies received during the study period were reviewed and cases of vesiculobullous disorders were selected for detailed study. Direct immunofluorescent (DIF) staining was done on these cases using fluorescein isothiocyanate conjugate (FITC) labelled antibodies for IgG, IgA, IgM, C3c and Fibrinogen. The data was analysed statistically using SPSS software. Results: A total of 62 DIF proven cases of vesiculobullous disorders of skin were studied. Pemphigus vulgaris (PV) was found to be the most frequent disorder (32.25%) followed by bullous pemphigoid (BP) with a frequency of 27.42%. The relative frequencies of pemphigus foliaceus (PF), dermatitis herpetiformis (DH), childhood bullous pemphigoid (CBP) and chronic bullous dermatosis of childhood (CBDC) were 20.96%, 6.45%, 4.83% and 6.45% respectively. One case each of IgA pemphigus (IgAP) and herpes gestationis (HG) were seen. IgA pemphigus can only be diagnosed after having observed the immunofluorescence pattern of this disorder. Conclusions: Definitive diagnosis of certain blistering lesions of skin requires the DIF microscopy. However, in special circumstances it needs to be reinforced with either salt split skin technique or immune electron microscopy.

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