Clinicopathological study of 55 cases of immunobullous diseases in Jordan

Abstract

Abstract: Background: Immunobullous skin diseases are a serious group of skin disorders with variable presentations that need to be diagnosed early for better prognosis. A proper clinical and histopathological evaluation is needed for correct diagnosis , so it is an important issue to share experience and to highlight this hot spot in dermatology. Object: To have a clinical and histopathological insight into the immunobullous skin diseases as a group to show their distribution in our region and to share experience for proper early diagnosis Material and Methods : All cases of immunobullous skin diseases that had been diagnosed at a referral centers in Jordan , Amman (King Hussein Medical Center , Jordan University hospital) and in private practice from Jan. 2000 to Jan. 2012 were included in this study . All cases were analyzed clinically and histopathologically . Hemotoxylin and Eosin stained sections were used for histopathological analysis . Immunoflourscence study was done on 16 cases and Tzanck smear examination after staining with Giemsa stain was done on 5 cases . Results : From Jan. 2000 to Jan. 2012 a total number 55 cases of different immunobullous skin diseases from a total number of 2156 skin biopsy that had been performed and examined during that period of time . There were 21 male patient and 34 female patient with M:F ration 1.2 : 2 . Age range of the patient is 4-85 yr. The distribution of different immunobullous diseases in decreasing frequency was ; bullous pemphigoid 24 patients (44%) , Pemphigus vulgaris 14 patient (25%) , Pemphigns folaceous 5 cases (9%) , Pemphigoid gesatations 4 patient 4(7%) , dermatitis herpeliformes 3 patients (5%) chronic bullous dermatosis of childhood 2 patients (8%) pemphigus erythematosus one patient (4%) , linear IgA dermatosis one patient 4% and lichen planus Pemphigoides one patient (4%) . Histopathological features were conclusive in most of the cases. Tazanck smear test was a helpful test in cases of pemphigus group . The study reveal rare form of presentations of pemphigus vulgaris as scalp lesions only . Rare histopathological features of bullous pemphigoid like cell poor blister and festooning were also seen . Conclusion : Immunobullous skin diseases are a serious skin diseases that affect all age groups , Proper clinical and histopathological examination is essentially conclusive for diagnosis . In some cases immunoflourscence study is essentially needed for diagnosis . Simple bedside test like Tzanck smear test is helpful in some cases .