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Utility of Direct Immunofluorescence in Cutaneous Autoimmune Bullous Disorders

Background Autoimmune bullous disorders (AIBD) are a heterogeneous group of disorders with substantial clinical overlap associated with blistering of skin or mucosa. Aims The present study aimed to study the histopathological spectrum and evaluate the utility of direct immunofluorescence (DIF) on sn...

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Autores principales: Brar, Arika, Sharma, Abhimanyu, Nauhria, Samal, Nauhria, Shreya, Bhattacharjee, Aniruddha, Peela, Jagannadha, Joshi, Kusum
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8133519/
https://www.ncbi.nlm.nih.gov/pubmed/34026378
http://dx.doi.org/10.7759/cureus.14562
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author Brar, Arika
Sharma, Abhimanyu
Nauhria, Samal
Nauhria, Shreya
Bhattacharjee, Aniruddha
Peela, Jagannadha
Joshi, Kusum
author_facet Brar, Arika
Sharma, Abhimanyu
Nauhria, Samal
Nauhria, Shreya
Bhattacharjee, Aniruddha
Peela, Jagannadha
Joshi, Kusum
author_sort Brar, Arika
collection PubMed
description Background Autoimmune bullous disorders (AIBD) are a heterogeneous group of disorders with substantial clinical overlap associated with blistering of skin or mucosa. Aims The present study aimed to study the histopathological spectrum and evaluate the utility of direct immunofluorescence (DIF) on snap-frozen and paraffin-embedded sections in resolving the differential diagnosis of AIBD and connective tissue disorders of the skin. We also compared the efficacy of DIF on paraffin versus the snap-frozen sections in diagnosing AIBD. Methods The present study was conducted for three years (2017-2019) and included 27 biopsies. We also included a retrospective analysis that included 25 biopsies collected over three years (2014-2017). Histopathological examination and DIF were conducted on all samples. Results Pemphigus vulgaris was the most common autoimmune cutaneous disorder constituting 37% (n = 10) in prospective and 36% (n = 9) in the retrospective study. DIF showed a specificity of 81.25% in our prospective study. While on the paraffin-embedded sections, it showed a specificity of 66.6% in our retrospective study. In the prospective study, DIF on paraffin-embedded sections had a positivity rate of 43.75% as compared to 81.25% in DIF done on snap-frozen sections. Conclusion DIF is a sensitive tool for the diagnosis as well as distinguishing immune-mediated bullous disorders from other lesions primarily when performed on snap-frozen sections. The diagnostic yield is enhanced by DIF in cases that pose a diagnostic dilemma both clinically and histologically. The final diagnosis depends on all clinical, histopathological and immunofluorescence findings.
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spelling pubmed-81335192021-05-21 Utility of Direct Immunofluorescence in Cutaneous Autoimmune Bullous Disorders Brar, Arika Sharma, Abhimanyu Nauhria, Samal Nauhria, Shreya Bhattacharjee, Aniruddha Peela, Jagannadha Joshi, Kusum Cureus Dermatology Background Autoimmune bullous disorders (AIBD) are a heterogeneous group of disorders with substantial clinical overlap associated with blistering of skin or mucosa. Aims The present study aimed to study the histopathological spectrum and evaluate the utility of direct immunofluorescence (DIF) on snap-frozen and paraffin-embedded sections in resolving the differential diagnosis of AIBD and connective tissue disorders of the skin. We also compared the efficacy of DIF on paraffin versus the snap-frozen sections in diagnosing AIBD. Methods The present study was conducted for three years (2017-2019) and included 27 biopsies. We also included a retrospective analysis that included 25 biopsies collected over three years (2014-2017). Histopathological examination and DIF were conducted on all samples. Results Pemphigus vulgaris was the most common autoimmune cutaneous disorder constituting 37% (n = 10) in prospective and 36% (n = 9) in the retrospective study. DIF showed a specificity of 81.25% in our prospective study. While on the paraffin-embedded sections, it showed a specificity of 66.6% in our retrospective study. In the prospective study, DIF on paraffin-embedded sections had a positivity rate of 43.75% as compared to 81.25% in DIF done on snap-frozen sections. Conclusion DIF is a sensitive tool for the diagnosis as well as distinguishing immune-mediated bullous disorders from other lesions primarily when performed on snap-frozen sections. The diagnostic yield is enhanced by DIF in cases that pose a diagnostic dilemma both clinically and histologically. The final diagnosis depends on all clinical, histopathological and immunofluorescence findings. Cureus 2021-04-19 /pmc/articles/PMC8133519/ /pubmed/34026378 http://dx.doi.org/10.7759/cureus.14562 Text en Copyright © 2021, Brar et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Dermatology
Brar, Arika
Sharma, Abhimanyu
Nauhria, Samal
Nauhria, Shreya
Bhattacharjee, Aniruddha
Peela, Jagannadha
Joshi, Kusum
Utility of Direct Immunofluorescence in Cutaneous Autoimmune Bullous Disorders
title Utility of Direct Immunofluorescence in Cutaneous Autoimmune Bullous Disorders
title_full Utility of Direct Immunofluorescence in Cutaneous Autoimmune Bullous Disorders
title_fullStr Utility of Direct Immunofluorescence in Cutaneous Autoimmune Bullous Disorders
title_full_unstemmed Utility of Direct Immunofluorescence in Cutaneous Autoimmune Bullous Disorders
title_short Utility of Direct Immunofluorescence in Cutaneous Autoimmune Bullous Disorders
title_sort utility of direct immunofluorescence in cutaneous autoimmune bullous disorders
topic Dermatology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8133519/
https://www.ncbi.nlm.nih.gov/pubmed/34026378
http://dx.doi.org/10.7759/cureus.14562
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