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A Two Year Retrospective Study of Direct Immunofluorescence in Autoimmune Vesiculobullous Lesions with Clinical Correlation

INTRODUCTION Cutaneous autoimmune non-infectious vesiculobullous diseases are a group of uncommon disorders, characterised by presence of autoantibodies against epithelial and mucosal intercellular antigens. Incidence varies from 0.09 to 1.8% in India [1]. Due to their overlapping clinical and histological features, many times they are source of diagnostic dilemma. So adjunctive Immuno-fluorescence (IF) method plays a crucial role in the diagnosis of these lesions. IF is a histochemical staining technique which detects antibodies in the tissue and body fluids. It not only aids in diagnosis, also helps in monitoring disease activity and predicting relapse [2,3]. IF is of three types; direct, indirect and complement indirect method. Direct IF (DIF) is a one-step method in which Fluorescein isothiocyanate (FITC) conjugates are applied over patient’s skin biopsy which detects antibodies against skin giving highly specific and low false positive results. Indirect IF in contrast is a two-step technique using patient’s serum. Though it is sensitive, rate of false positive results are also high. Complement indirect method is a three step procedure assessing complement binding ability of autoantibodies, so making it most specific method [4]. The aim of this study was to analyse the pattern, intensity and contribution of IF in diagnosis of various autoimmune vesiculobullous lesions with clinical correlation even in absence of histopathological study.