Comparison of the diagnostic efficacy of Tzanck smear with histopathology and direct immunofluorescence in immunobullous disorders

Abstract

Introduction: The immunobullous disorders have severe impact on the patients and their family and have severe economic and health related consequences associated with pain, agony and loss of manpower. Tzanck smear being a bed side test can aid in establishing the clinical diagnosis with ease and rapidity and can serve as an adjunct to routine histological study. This study was undertaken to assess the utility of Tzanck test for early diagnosis of various immunobullous disorders and correlate the findings with histopathology and direct immunofluorescence. Objectives: 1.To study Tzanck smear, histopathology, and immunofluorescence patterns in immunobullous disorders. 2.To evaluate diagnostic efficacy and sensitivity of Tzanck smear findings in comparison to histopathology and direct immunofluorescence in clinically suspected cases of immunobullous disorders. Materials and Methods: A total of 38 cases clinically diagnosed immunobullous disorders were appraised during the study. The patients were subjected to Tzanck smear, skin biopsy for histopathology and direct immunofluorescence. The specimen was sent in 10% buffered formalin and normal saline for routine histological analysis and DIF respectively to the department of Pathology. The resulting data was tabulated and statistically analysed for comparison using sensitivity test. Conclusion: Tzanck smear served as a simple, rapid and non invasive bedside diagnostic tool, which was cost effective and yield ed quick results. It can be concluded that in pemphigus group of disorders, Tzanck smear is 100% sensitive, can yield quick results and can serve as first line of investigation rather than histopathology and DIF which is expensive and takes time for reporting. Results: Pemphigus vulgaris was the most common immunobullous disease seen in this study, followed by bullous pemphigoid. Tzanck smear served as a rapid diagnostic tool and showed 100% sensitivity in all the pemphigus group of disorders which was compar ed with h