Abstract
Introduction: Pemphigus refers to a group of chronic cutaneous autoimmune blistering diseases caused by antidesmosomal antibodies leading to acantholysis with consequent blisters.
Aims: To study the clinical, cytological, histopathological and immunofluorescence findings in pemphigus.
Methods: Thirty patients with pemphigus were studied. Tzanck smear could be done in 25 patients. Histopathology examination was carried out in 29 cases. Direct immunofluorescence was done in 29 patients. All the data were analysed using the computer software, statistical package for social science (SPSS) version 10.
Results: Of the 30 pemphigus patients studied, majority of males (53.3%) had onset in the age group 30-44 years and 53.3% of females had onset at a slightly higher age group. In 5 cases, onset of disease was noted in the age group >60 years. Two cases gave history of vesiculobullous disease in their siblings. Diabetes was present in 23.3% cases, thyroid disorders in 16.7% and hypertension in 10%. 40% showed Staphylococcus aureus growth, 13.7% with Methicillin resistant staphylococcus aureus and 6.3% had streptococcal growth. Tzanck smear was positive in 88%. By histopathological examination all the patients could be diagnosed as either pemphigus vulgaris or pemphigus foliaceus. In DIF study, 96.6% showed intercellular IgG and 86.2% cases showed C3.
Conclusion: All clinically diagnosed cases could be confirmed either by histopathology or DIF as pemphigus. Identification of type of pemphigus was possible by histopathology in 100% cases where it was done.
Keywords: pemphigus, Tzanck, Direct immunofluorescence, histopathology.
References
- Grandhe NP, Dogra S, Kanwar AJ. Multiple autoimmune syndrome in a patient with pemphigus vulgaris. Acta Derm Venereol 2005;85:91-2.
- Rai R, Harikumar MV. Comparison of direct immunofluorescence of plucked hair and skin for evaluation of immunological remission in pemphigus. Indian Dermatol Online J 2017; 8 :319-22.
- Sano SM, Quarracino MC, Aguas SC, González EJ, Harada L, Krupitzki H et al. Sensitivity of direct immunofluorescence in oraldiseases. Study of 125 cases. Med Oral Patol Oral Cir Bucal 2008;13(5):287-91.
- Naseer SY, Gill L, Shah J, Sinha AA .Gender-based variability in disease presentation in pemphigus vulgaris. J Drugs Dermatol 2014 ;13(10):1225-30.
- Chowdhury J, Datta PK, Chowdhury SN, Das NK. A clinicopathological study of pemphigus in Eastern India withspecial reference to direct immunofluorescence. Indian J Dermatol2016;61:288-94.
- Asia AJ, Laul RA. Clinico-Epidemiological Profile of Pemphigus: An Observational Study JMSCR 2015; 3 (8): 7090-94.
- Javidi Z, Meibodi NT, Nahidi Y. Epidemiology of pemphigus in northeast Iran: A 10-year retrospective study.Indian J Dermatol 2007;52(4):188-91.
- Kridin K, Zelber-Sagi S, Comaneshter D, Cohen AD. Coexistent Solid Malignancies in Pemphigus- A Population-Based Study. JAMA Dermatol 2018; 154(4): 435–440.
- Shamim T, Varghese VI, Shameena PM, Sudha S. Pemphigus vulgaris in oral cavity: Clinical analysis of 71 cases. Med Oral Patol Oral Cir Bucal 2008;13(10): 22-6.
- Mini PN, Sadeep MS .Pemphigus – A clinical study with clinico-immuno-histopathologiccorrelation. J Mahatma Gandhi Inst Med Sci 2019; 24:91-5.
- Prabhu SS, Ravi D, ShenoiSD ,Pai K, Nayak SUK. Multiple autoimmune syndrome with isotopicphenomenon: association of lichen planus, vitiligo and alopecia areata with autoimmune hepatitis. Journal of Pakistan Association of Dermatologists 2018; 28(3): 356-59.
- Esmaili N,Mortazavi H, Noormohammadpour P, Boreiri M, Soori T, Vasheghani Farahani I et al. Pemphigus Vulgaris and Infections: A Retrospective Study on 155 Patients. Autoimmune Dis 2013; 834295. doi: 1155/2013/834295.
- Basu K, Chatterjee M, De A, Sengupta M, Datta C, Mitra P. A clinicopathological and immunofluorescence study of intraepidermalimmunobullous diseases. Indian J Dermatol 2019;64:101-5.
- Ljubojević S, Lipozencić J, Brenner S, Budimcić D. Pemphigus vulgaris: a review of treatment over a 19-year period. J Eur Acad Dermatol Venereol 2002 ;16 (6):599-603.
- Mahajan A, Kaur J, Manjari M, Sharma S, Bains P, Awal G et al. Oral pemphigus vulgaris: clinicopathological study of 35 cases at a tertiary care centre in North India .Int J Res Dermatol 2017 ; 3(2):192-95.
- Mimouni D, Anhalt GJ, Lazarova Z, Aho S, Kazerounian S, Kouba DJ, et al. Paraneoplastic pemphigus in children and adolescents. Br J Dermatol 2002;147:725–32.
- Arbache ST, Nogueira TG, Delgado L, Miyamoto D, Aoki V. Immunofluorescence testing in the diagnosis of autoimmune blistering diseases: overview of 10-year experience. An Bras Dermatol 2014;89(6):885-9.
- Arundhathi S, Ragunatha S, Mahadeva K.C.A cross- sectional study of clinical, histopathological and direct immunofluorescence spectrum of vesiculobullous disorders. J Clin Diagn Res 2013 Dec; 7(12): 2788– 92.
- Balighi K, Taheri A, MansooriP .Value of direct immunofluorescence in predicting remission in pemphigus vulgaris. Int J Dermatol 2006; 45:1308–11.
Corresponding Author
Dr Sheena Ann Simon
Assistant Professor, Dept. of Dermatology & Venereology, Govt. Medical College, Thiruvananthapuram.