Clinico-pathological spectrum of vesiculobullous diseases: A prospective cross-sectional study.

Dr. Nidhi  Naik; Dr. Sudhamani  Srinath; Dr. Prakash  Dive

doi:10.51168/sjhrafrica.v6i9.2112

Authors

Dr. Nidhi Naik Senior Resident, Department of Pathology, D Y Patil School of Medicine, Navi Mumbai, Maharashtra, India
Dr. Sudhamani Srinath Professor and Head, Department of Pathology, D Y Patil School of Medicine, Navi Mumbai, Maharashtra, India
Dr. Prakash Dive Assistant Professor, Department of Pathology, D Y Patil School of Medicine, Navi Mumbai, Maharashtra, India

DOI:

https://doi.org/10.51168/sjhrafrica.v6i9.2112

Keywords:

Vesiculobullous lesion, pemphigus, bullous pemphigoid, immunofluorescence, histopathology

Abstract

Background:
Vesiculobullous lesions are a heterogeneous group of disorders characterized by fluid-filled cutaneous lesions of varied etiology, including autoimmune, genetic, drug-induced, and infectious causes. Due to overlapping clinical presentations, diagnosis based on clinical features alone is challenging. Histopathology and direct immunofluorescence (DIF) are crucial adjuncts, enhancing accuracy, guiding therapy, and informing prognosis.

Objectives:

To evaluate the histopathological features of vesiculobullous skin disorders, correlate them with clinical findings, and assess the utility of DIF in achieving a definitive diagnosis. Additional objectives were to classify lesions by age, sex, and distribution.

Methods:

This prospective cross-sectional study was conducted in the Department of Pathology, D.Y. Patil School of Medicine, Navi Mumbai. A minimum of 50 clinically suspected cases were enrolled; 56 were analyzed. Clinical history, dermatological examination, and punch biopsies were performed. Routine histopathology was supplemented with DIF in selected cases. Data were analyzed using descriptive statistics.

Results:

The most commonly affected age group was 21–30 years (23.2%). A slight male predominance was noted (53.6%), with a male-to-female ratio of 1:0.87. The trunk was the most frequent site (41%). Clinically, pemphigus vulgaris was most common (23.2%), followed by bullous pemphigoid (12.5%) and Stevens–Johnson syndrome (12.5%). Histopathology revealed intraepidermal blisters as the most frequent pattern (35.7%). DIF showed granular IgG and C3 positivity in pemphigus vulgaris and linear IgG/C3 deposition along the dermoepidermal junction in bullous pemphigoid.

Conclusion:

Clinical features alone are insufficient for accurate categorization of vesiculobullous lesions. Histopathology remains the gold standard, while DIF provides valuable confirmation when findings are inconclusive. Integrating these approaches ensures precise diagnosis, timely treatment, and better prognostic guidance, particularly in autoimmune bullous diseases.

Recommendations:

Routine biopsies with clinicopathological correlation should be emphasized. DIF should be integrated whenever feasible, with improved accessibility and clinician–pathologist collaboration to optimize patient outcomes.

Author Biographies

Dr. Nidhi Naik, Senior Resident, Department of Pathology, D Y Patil School of Medicine, Navi Mumbai, Maharashtra, India

is currently serving as a Senior Resident in the Department of Pathology at D.Y. Patil School of Medicine, Navi Mumbai, Maharashtra, India. She completed her MBBS from K.S. Hegde Medical Academy, Mangalore, Karnataka, and pursued her post-graduation in Pathology at D.Y. Patil School of Medicine, Navi Mumbai. Her academic and clinical expertise reflect a strong commitment to diagnostic pathology and research. ORCID ID: https://orcid.org/0009-0003-6076-7852

Dr. Sudhamani Srinath, Professor and Head, Department of Pathology, D Y Patil School of Medicine, Navi Mumbai, Maharashtra, India

has completed MBBS and MD Pathology, both from JSS Medical College Mysuru, under Mysuru University in 1999 and from Rajiv Gandhi University of Health Sciences, Karnataka in 2003, respectively. She joined prestigious DY Patil Medical College, Hospital, and research center, Navi Mumbai, as an Assistant Professor in 2004 and, since then, has been teaching and guiding both MBBS and MD students in various projects and research activities. She has handled pivotal responsibilities including Histopathology, cytology, clinical Pathology, and other academic activities. She has published more than 70 research papers in both National and international journals. Currently, she is serving as Professor and Head of the Department of Pathology in the same institute.https://orcid.org/0000-0002-5213-6394

Dr. Prakash Dive, Assistant Professor, Department of Pathology, D Y Patil School of Medicine, Navi Mumbai, Maharashtra, India

has completed his M.B.B.S. from Topiwala National Medical College and B.Y. L. Nair Charitable Hospital, Mumbai in the year 2004. He also completed his M.D. Pathology from G.S. Medical College and K.E.M. Hospital, Mumbai, in the year 2010. He joined the prestigious D.Y. Patil School of Medicine, Hospital and Research Centre, Navi Mumbai, Maharashtra, as an Assistant Professor in the year 2022 and has been working as a teaching faculty to both M.B.B.S. and M.D. Pathology students with over 10 years of experience in the field of Pathology and Laboratory Medicine. He authored several publications in several journals to his credit and contributed to medical education.https://orcid.org/0009-0008-8193-170X

References

Dayananda S Biligi, Shubhashree M N, Histopathological Study of Vesiculobullous lesions of skin, Int J Biol Med Res 2015; 6(2): 4966-4972.

Mysorekar VV, Sumathy TK, Shyam Prasad AL. Role of direct immunofluorescence in dermatological disorders. Indian Dermatol Online J 2015; 6:172-80 https://doi.org/10.4103/2229-5178.156386

Garg R, Bhojani K. Non-infective bullous lesions: a diagnostic challenge in a minimally equipped centre- based solely on microscopic findings. Afri Health Sci. 2020; 20(2): 885-890. https://doi.org/10.4314/ahs.v20i2.42

Raja Vojjala, K. Shyam Sunder. Histopathological study of non-infectious vesiculobullous lesions of skin. IAIM, 2020; 7(5): 39-43.

Gilks Blake. Ovary. John R. Goldblum, Laura W. Lamps, Jesse K. McKenney, Jeffrey L. Myers (Ed.) (2018), Rosai and Ackerman's Surgical Pathology. Philadelphia, Elsevier.

Shekhawat Pratibha, Yadav Ajay, Udawat Hema, Ranawat Chandrajeet Singh, Kotia Suman, Clinico-histopathological Study of Vesiculobullous Lesions of the Skin at Tertiary Care Centre, JMSCR Vol||08||Issue||03||Page 716-724||March 2020. https://doi.org/10.18535/jmscr/v8i3.122

Annu Elizabeth Prakash, Jessy Mangalathu Mathai, Thundi Parampil Thankappan, and Gopalan Sulochana, A Clinicopathological Study of Immunobullous Diseases, Annals of Pathology and Laboratory Medicine, Vol. 6, Issue 2, February 2019. https://doi.org/10.21276/APALM.2179

Deepti SP, Sulakshana MS, Manjunatha YA, Jayaprakash HT. A histomorphological study of bullous lesions of skin with special reference to immunofluorescence. Int J Curr Res Acad Rev.2015;3(3):29-51

Anupama Raj Karattuthazhathu, Letha Vilasiniamma, Usha Poothiode, A Study of Vesiculobullous Lesions of Skin, National Journal of Laboratory Medicine. 2018 Jan, Vol-7(1): PO01-PO06.

Kumar SS, Atla B, Prasad PG, Srinivas KSS, Samantra S, Priyanka ALN. Clinical, histopathological, and immunofluorescent study of vesicobullous lesions of skin. Int J Res Med Sci 2019; 7:1288-95. https://doi.org/10.18203/2320-6012.ijrms20191341

Arundhathi S, Ragunatha S, Mahadeva K.C., A Cross-sectional Study of Clinical, Histopathological and Direct Immunofluorescence Spectrum of Vesiculobullous Disorders, Journal of Clinical and Diagnostic Research. 2013 Dec, Vol-7(12): 2788-2792.

Gupta S, Varma AV, Sharda B, Malukani K, Malpani G, Sahu H. Histopathological findings of vesiculobullous lesions of skin in relation to their clinical presentation: Prospective study from a tertiary care center. MGM J Med Sci 2022; 9:448-58. https://doi.org/10.4103/mgmj.mgmj_154_22

Anirudha Vasantacharya Kushtagi, Vijayashree Shivappa Neeravari, Sidhalingreddy, Pratima S et al, Clinical and Histopathological Spectrum of Vesciculobullous Lesions of Skin- A Study of 40 cases, Indian Journal of Pathology and Oncology, April-June 2016;3(2);152-158. https://doi.org/10.5958/2394-6792.2016.00031.4

Ashutosh Kumar, Ankita Mittal, Rashmi Chauhan, Faiyaz Ahmad, Seema Awasthi, S. Dutta, Histopathological Spectrum of Vesiculobullous Lesions of the Skin: Study at a Tertiary Care Hospital, Int J Med Res Prof.2018 July; 4(4); 250-55.

Ahmed K, Rao TN, Swarnalatha G, Amreen S, Kumar AS. Direct immunofluorescence in autoimmune vesiculobullous disorders: a study of 59 cases. J Dr. NTR Univ Heal Sci. 2014;3(3):164. https://doi.org/10.4103/2277-8632.140935

Shekhawat Pratibha, Yadav Ajay, Udawat Hema, Ranawat Chandrajeet Singh, Kotia Suman, Clinico-histopathological Study of Vesiculobullous Lesions of the Skin at Tertiary Care Centre, JMSCR Vol||08||Issue||03||Page 716-724||March 2020. https://doi.org/10.18535/jmscr/v8i3.122

Anchal Jindal, Rushikesh Shah, Neela Patel, Krina Patel, Rupal P. Mehta, Jigna P. Barot, A cross-sectional study of clinical, histopathological, and direct immunofluorescence diagnosis in autoimmune bullous diseases, Indian Journal of Dermatopathology and Diagnostic Dermatology, 2014 Jan-Jun /Vol 1/Issue 1. https://doi.org/10.4103/2349-6029.

Charisma Kunhi Khannan, Dr Ramesh Bhat M, A retrospective study of clinical, histopathological, and direct immunofluorescence spectrum of immunobullous Disorders, International Journal of Scientific and Research Publications, Volume 5, Issue 9, September 2015, ISSN 2250-3153.