Diagnostic Role of Direct Immunofluorescence Assay in Determining The Etiology of Erythroderma: Experience in a Tertiary Referral Hospital

Ecem Bostan; Ozay Gokoz; Sibel  Dogan; Duygu Gulseren; Neslihan Akdogan; Basak Yalici-armagan; Sibel Ersoy-Evans; Gonca Elcin; Aysen Karaduman

doi:10.5826/dpc.1204a160

Diagnostic Role of Direct Immunofluorescence Assay in Determining The Etiology of Erythroderma: Experience in a Tertiary Referral Hospital

Authors

Ecem Bostan Department of Dermatology and Venereology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
Ozay Gokoz Department of Pathology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
Sibel Dogan Department of Dermatology and Venereology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
Duygu Gulseren Department of Dermatology and Venereology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
Neslihan Akdogan Department of Dermatology and Venereology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
Basak Yalici-armagan Department of Dermatology and Venereology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
Sibel Ersoy-Evans Department of Dermatology and Venereology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
Gonca Elcin Department of Dermatology and Venereology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
Aysen Karaduman Department of Dermatology and Venereology, Hacettepe University, Faculty of Medicine, Ankara, Turkey

Keywords:

fluorescent antibody technique, immunobullous diseases, erythroderma

Abstract

Introduction: Erythroderma is a life-threatening dermatologic emergency which is characterized by diffuse erythema and exfoliation affecting more than 90% of the body surface area. Most common cutaneous diseases associated with erythroderma are systemic contact dermatitis, psoriasis, drug eruption and atopic dermatitis. Clinicopathological correlation is used to determine the underlying disease. In addition, direct immunoflurorescence (DIF) may provide significant clues for etiology of erythroderma especially in the case of autoimmune bullous skin diseases (ABSDs).

Objectives: In our study, we aimed to analyze the demographic data, clinical prediagnoses, final diagnosis, histopathological and DIF examination findings, accompanying systemic signs and laboratory abnormalities of erythrodermic patients.

Methods: We conducted a retrospective study of 31 erythroderma patients in a referral hospital between 2014 and 2021. Cutaneous biopsies were taken from all patients for Hematoxyin&Eosin and DIF examination.

Results: Average age was 54. 6 ± 23 years. 48.4% of the patients were female (n=15) whereas 51.6 % of the patients were male (n=16). Average time between the onset of rash and biopsy was 18.8 days. DIF analysis showed immune deposits in 19.4% (n=6) of the patients; whereas no immune deposits were detected in 80.6% (n=25) of the patients. The most frequent final diagnosis was adverse cutaneous drug eruption followed by ABSDs.

Conclusions: Our findings suggest that DIF may be used in conjunction with clinicopathologic and clinical findings to reveal the associated skin diseases in erythrodermic patients. Erythrodermic patients presenting with clinical findings of ABSD should be considered for DIF examination.

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