A Multimodal Approach to Diagnosis of Immunobullous Diseases: Integrating Clinical, Histopathological, and Immunofluorescence Findings.

INTRODUCTION

Autoimmune bullous dermatoses (ABD) are rare but potentially debilitating skin disorders characterized by autoantibody-mediated blistering of the skin and mucosa. Timely and accurate diagnosis is critical for effective treatment and improving patient outcomes. To evaluate the diagnostic concordance between clinical assessment, histopathology (HP), and direct immunofluorescence (DIF) in patients with ABD and to examine the demographic and clinical patterns in a tertiary dermatology center in eastern India.

METHODS

This retrospective, cross-sectional study analyzed 196 cases of ABD diagnosed between January 2020 and August 2023. Clinical findings were correlated with histopathological examination (HPE) and DIF patterns to establish final diagnoses. Concordance between different diagnostic modalities was statistically assessed using McNemar's test.

RESULTS

Bullous pemphigoid (BP) was the most prevalent diagnosis (58.1%), followed by pemphigus vulgaris (PV; 20.9%) and pemphigus foliaceus (PF; 11.2%). In the geriatric population, BP was predominant (81.1%), while PV and PF were more common in females. The highest diagnostic concordance (97.9%) was observed when clinical findings were combined with both HP and DIF. Four cases of epidermolysis bullosa acquisita (EBA) were diagnosed only after salt-split DIF.

CONCLUSION

An integrated diagnostic approach combining clinical, histopathological, and DIF findings significantly enhances diagnostic accuracy in autoimmune bullous diseases. Given the rising prevalence of BP, especially among the elderly, and the limitations of individual modalities, multimodal assessment should be the standard for optimal diagnosis and management.