HISTOMORPHOLOGICAL ANALYSIS OF SUBEPIDERMAL BULLOUS DISORDERS OF SKIN BY PERIODIC ACID-SCHIFF STAIN

Abstract

Background: Subepidermal bullous illnesses are autoimmune blistering diseases that exhibit notable clinicopathological overlap and separation at the dermoepidermal junction. For proper diagnosis and treatment, accurate distinction is crucial. The basement membrane zone can be highlighted by Periodic Acid–Schiff (PAS) stain, which can help determine the degree of separation.

Aim: Examine the histomorphological characteristics of subepidermal bullous diseases and assess the diagnostic value of PAS staining.

Materials and Methods: As part of this prospective investigation, 40 skin samples from clinically suspected bullous disorders were assessed over a one-year period using PAS and Hematoxylin and Eosin staining. Histomorphology, PAS staining patterns, and inflammatory infiltration were evaluated and linked to the diagnosis.

Results: With a female preponderance, bullous pemphigoid was the most prevalent entity (65%). Subepidermal blisters formed in all patients with the most common pattern being an eosinophil-rich infiltration (55%). In every instance, PAS staining brought attention to the basement membrane zone displaying a floor pattern in 80% of cases and a roof pattern in 20%. Whereas the roof pattern was observed in porphyria cutanea tarda, bullous lupus erythematosus, and epidermolysis bullosa acquisita, floor staining was primarily associated with bullous pemphigoid and lichen planus pemphigoides.

Conclusion: In conclusion, PAS provides a straight forward and reasonably priced addition to standard histology for the differentiation of subepidermal bullous diseases.