CONCORDANCE AND DISCORDANCE IN DERMATOLOGICAL DIAGNOSES: A COMPREHENSIVE REVIEW OF CLINICAL, HISTOLOGICAL AND IMMUNOFLUORESCENCE CORRELATION

Abstract

Dermatological diagnosis relies on integrating clinical examination, histological analysis, and immunofluorescence to ensure accuracy in identifying skin diseases. This study evaluates the concordance between clinical, histopathological, and direct immunofluorescence (DIF) diagnoses in 75 cases of skin lesions, encompassing both bullous and non-bullous types. Conducted at Saveetha Medical College, Chennai, from March 2023 to June 2024, the research utilized descriptive statistics and the Chi-square test to analyze data. Results underscored the pivotal role of immunofluorescence in enhancing diagnostic accuracy, particularly in immunobullous diseases characterized by autoantibodies targeting skin adhesion structures. Understanding the interplay among diagnostic modalities provides insights into improving diagnostic precision and treatment outcomes in dermatology. This study contributes to refining clinical practices by highlighting the significance of immunofluorescence in dermatological diagnostics. Bullous Pemphigoid emerged as the predominant diagnosis, comprising 54.7% of cases, followed by Systemic Lupus Erythematosus (20%), Cutaneous Small Vessel Vasculitis (12%), Pemphigus Vulgaris (8%), and Pemphigus Foliaceus (5.3%). Concordance between clinical, histopathological, and immunofluorescence findings was high across all diagnoses, with 69 cases showing agreement among all three diagnostic methods. Discordance, observed in 6 cases, underscores challenges in diagnosis despite comprehensive evaluation. These findings emphasize the critical role of integrating diagnostic modalities to enhance accuracy in managing autoimmune skin diseases effectively.