Study of Various Vesiculobullous Lesions Using Tzanck Smear
Keywords:
vesicle, bulla, cytology, acantholysis
Abstract
Background: The vesiculobullous reaction pattern is characterized by the presence of vesicles or bullae within the epidermis or at the dermoepidermal junction. Despite some having characteristic presentations, it’s difficult to make a definite diagnosis clinically. Hence, cytological evaluation is required for reliable and early diagnosis. Objectives of the study are to determine the incidence of various vesiculobullous lesions and evaluate cytology as a tool for early diagnosis of vesiculobullous lesions. Methods: For Tzanck smears fresh vesicle or bulla was selected and incised with scalpel, reflecting the roof of bulla. Base of the blister scraped gently and material spread on a glass slide. These smears were stained with MGG (air dried), Pap and H&E stains (fixed).Skin punch biopsies from the bullae were subjected to routine fixation, processing, sectioning and staining. Results: A total of 62 Tzanck smears were done for vesiculobullous lesions of skin of which 29 had histopathological correlation. Herpes constituted the most common vesiculobullous disorder (42%) followed by bullous pemphigoid (27.4%) and pemphigus vulgaris (19.3%). Most patients were in the age group 61- 70 years. The M:F ratio of 1:1.38 showing female preponderance. Tzanck smears showed acantholytic cells in pemphigus group, eosinophils in bullous pemphigoid and multinucleate giant cells in viral blisters. Histopathology showed intraepidermal acantholysis in pemphigus vulgaris, subcorneal blister in pemphigus foliaceus and subepidermal in bullous pemphigoid. Conclusion: Cytohistopathological correlation showed an overall sensitivity of 79%. Tzanck smear showed 96% sensitivity for viral infections. Tzanck smear is a quick, non-invasive method for the early diagnosis of vesiculobullous disorders.References
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2. Barr RJ. Cutaneous cytology. J Am Acad Dermatol 1984;10:163-80.
3. Ruocco V, Ruocco E. Tzanck smear, an old test for the new millennium: when and how? Int J Dermatol 1999;38:830-4.
4. Graham JH, Bingul O, Burgoon CF Jr. Cytodiagnosis of inflammatory dermatosis: Pitfalls in evaluation of smears. Arch Dermatol 1963;87:18-27.
5. Blank H, Burgoon CF Jr. Abnormal cytology of epithelial cells in pemphigus vulgaris: A diagnostic aid. J Invest Dermatol 1952;18:213-23.
6. Solomon AR, Rasmussen JE, Weiss JS. A comparison of the Tzanck smear and viral isolation in varicella and herpes zoster. Arch Dermatol 1986;122:282-5.
7. Wu H, Schapiro B, Harrist TJ. Noninfectious vesiculobullous and vesiculopustular diseases. In: Elder D, Elenitsas R, Johnson BL, Murphy GF, ed. Lever's histopathology of the skin, 9th edition. Philadelphia: Lippincott Williams and Wilkins, 2005: p243-291.
8. Mittal H et al. A study of clinicopathologic spectrum of vesicobullous disorders. Int J Res Dermatol. 2017 Sep;3(3):355-364.
9. Khadse V et al. The study of vesicobullous skin lesions by Tzanck smear cytology. IP Archives of Cytology and Histopathology Research, April-June 2018;3(2):61-64.
10. Krishnamurthy T et al. Histopathological Study of Vesiculobullous lesions of skin. Int J Biol Med Res. 2015; 6(2): 4966-4972.
11. Sabir F, Aziz M, Afroz N, Amin SS. Clinical and cytohistopathological evaluation of skin lesions with special reference to bullous lesions. Indian J Pathol Microbiol 2010; 53(10): 41-46.
12. Durdu M, Baba M,Sekin D. The value of Tzanck smear test in diagnosis of erosive, vesicular, and pustular skin lesions. J Am Acad Dermatol. 2008; 59: 958-64.
13. Deepti S, Sulakshana MS, Manjunatha YA, Jayaprakash HT. A histomorphological study of bullous lesions of skin with special reference to immunofluorescence. Int J Curr Res Aca Rev. 2015; 3(3): 29-51.
14. Arundhathi S, Raghunatha S, Mahadeva KC. A Cross–sectional study of clinical, histopathological and direct immunofluorescence spectrum of vesiculobullous disorders. J Clin Diagn Res. 2013; 7(12); 2788-92.
15. Heera K P, Anoop T V, Ajaya Kumar S, Robins K, Rajiv S. The significance of tzanck smear in evaluation of vesiculo bullous skin lesions in correlation with clinical diagnosis - a cross sectional study. International Journal of Contemporary Medical Research 2017;4(2):337-340.
2. Barr RJ. Cutaneous cytology. J Am Acad Dermatol 1984;10:163-80.
3. Ruocco V, Ruocco E. Tzanck smear, an old test for the new millennium: when and how? Int J Dermatol 1999;38:830-4.
4. Graham JH, Bingul O, Burgoon CF Jr. Cytodiagnosis of inflammatory dermatosis: Pitfalls in evaluation of smears. Arch Dermatol 1963;87:18-27.
5. Blank H, Burgoon CF Jr. Abnormal cytology of epithelial cells in pemphigus vulgaris: A diagnostic aid. J Invest Dermatol 1952;18:213-23.
6. Solomon AR, Rasmussen JE, Weiss JS. A comparison of the Tzanck smear and viral isolation in varicella and herpes zoster. Arch Dermatol 1986;122:282-5.
7. Wu H, Schapiro B, Harrist TJ. Noninfectious vesiculobullous and vesiculopustular diseases. In: Elder D, Elenitsas R, Johnson BL, Murphy GF, ed. Lever's histopathology of the skin, 9th edition. Philadelphia: Lippincott Williams and Wilkins, 2005: p243-291.
8. Mittal H et al. A study of clinicopathologic spectrum of vesicobullous disorders. Int J Res Dermatol. 2017 Sep;3(3):355-364.
9. Khadse V et al. The study of vesicobullous skin lesions by Tzanck smear cytology. IP Archives of Cytology and Histopathology Research, April-June 2018;3(2):61-64.
10. Krishnamurthy T et al. Histopathological Study of Vesiculobullous lesions of skin. Int J Biol Med Res. 2015; 6(2): 4966-4972.
11. Sabir F, Aziz M, Afroz N, Amin SS. Clinical and cytohistopathological evaluation of skin lesions with special reference to bullous lesions. Indian J Pathol Microbiol 2010; 53(10): 41-46.
12. Durdu M, Baba M,Sekin D. The value of Tzanck smear test in diagnosis of erosive, vesicular, and pustular skin lesions. J Am Acad Dermatol. 2008; 59: 958-64.
13. Deepti S, Sulakshana MS, Manjunatha YA, Jayaprakash HT. A histomorphological study of bullous lesions of skin with special reference to immunofluorescence. Int J Curr Res Aca Rev. 2015; 3(3): 29-51.
14. Arundhathi S, Raghunatha S, Mahadeva KC. A Cross–sectional study of clinical, histopathological and direct immunofluorescence spectrum of vesiculobullous disorders. J Clin Diagn Res. 2013; 7(12); 2788-92.
15. Heera K P, Anoop T V, Ajaya Kumar S, Robins K, Rajiv S. The significance of tzanck smear in evaluation of vesiculo bullous skin lesions in correlation with clinical diagnosis - a cross sectional study. International Journal of Contemporary Medical Research 2017;4(2):337-340.
Published
2020-07-07
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