Izvorni znanstveni članak
What has Better Diagnostic Accuracy in Pemphigus? Direct Immunofluorescence of Plucked Hair, Oral Scrapes or Tzanck Smears!
Vinita Paswan
; Department of Pathology and Lab Medicine, AIIMS, Raebareli, UP, India
Sonal Sharma
; Department of Pathology, UCMS, & Guru Teg Bahadur Hospital, Delhi, India
*
Sambit Nath Bhattacharya
; Department of Dermatology & STD, RML Hospital, New Delhi
Usha Rani Singh
; Department of Pathology, UCMS, & Guru Teg Bahadur Hospital, Delhi, India
* Dopisni autor.
Sažetak
ABSTRACT Background: Pemphigus is identified by the intercellular
deposition of immunoglobulin IgG on direct immunofluorescence
(DIF) within skin, hair follicles, and oral mucosa. The objective of this
study was to evaluate the diagnostic accuracy of DIF in hair, oral
mucosal scrapes, and Tzanck smears, with DIF of skin serving as the
reference standard.
Materials and methods: This cross-sectional observational study
included patients with clinically suspected pemphigus (n=70) selected
through non-probability sampling and compared them with
age-matched controls (n=70) who had non-pemphigus bullous lesions.
All participants underwent Direct Immunofluorescence (DIF)
of hair, oral mucosal scrapes, and Tzanck smears following histopathological
examination. The sensitivity, specificity, diagnostic accuracy,
and area under the receiver operating characteristic curve
(ROC) were calculated.
Results: Of the 70 clinically suspected cases of pemphigus, histopathology
confirmed 64 cases (91.4%) as pemphigus vulgaris and 6
cases (8.6%) as pemphigus foliaceus. Perilesional skin biopsy showed
a fish net pattern (intercellular IgG deposition) in 100% of pemphigus
cases. DIF of the outer root sheath of scalp anagen hair demonstrated
this pattern in 94.3% of cases. Tzanck smears from fresh
blisters showed pericellular membranous deposits on acantholytic
cells in 69.3% of cases. Oral scrapes DIF indicated pericellular deposition
around acantholytic cells in 65.7% of cases. Controls (n=4) also
exhibited IgG intercellular deposition (fish net pattern) on DIF. ROC
curve analysis revealed that hair DIF had a superior diagnostic accuracy
(AUC = 0.968), compared to oral scrapes DIF (AUC=0.917) and
Tzanck smear DIF (AUC=0.771), respectively.
Conclusion: DIF analysis of hair has superior diagnostic accuracy as
compared to oral and tzanck smear.
Ključne riječi
Pemphigus; Direct immunofluorescence; Skin biopsy; anagen hair; Tzanck smears
Hrčak ID:
346652
URI
Datum izdavanja:
10.4.2025.
Posjeta: 15 *