ReportThe value of Tzanck smear test in diagnosis of erosive, vesicular, bullous, and pustular skin lesions
Introduction
Cytology is a diagnostic tool used to investigate the characteristics of individual cells. In this method, materials obtained in a variety of ways are transferred to a glass slide, stained with various dyes, and then examined under the light microscope.1 As a method for the diagnosis of cutaneous disorders, cytology was first used by Arnault Tzanck in 1947.1, 2 Although it was suggested as a simple, rapid, and reliable technique to be used in the diagnosis of many diseases during the following 6 decades, the practice of cytodiagnosis has been limited to a few diseases.2 To date, therefore, only a few studies have examined the dermatological use and diagnostic value of this method.2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 The majority of these studies have related to herpetic infections,3, 4, 5, 6, 7 pemphigus,8, 9 cutaneous leishmaniasis,10 and cutaneous neoplasms, especially basal cell carcinoma.11, 12, 13, 14, 15, 16, 17
In this prospective study, we aimed to describe the Tzanck smear findings in patients with erosive, vesicular, bullous, and pustular skin lesions and determine the sensitivity and specificity of this test in some of the skin diseases studied. We also intended to develop an algorithmic approach for diagnosis of moist skin lesions using Tzanck smear test findings.
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Patients
Patients with erosive, vesicular, bullous, and pustular skin lesions who applied to the Department of Dermatology, Başkent University Faculty of Medicine, Adana Hospital between January 2006 and January 2008 and could not be diagnosed only by dermatological physical examination were included in the study. Demographic, clinical, and laboratory data including patients' age, sex, lesion types, characteristic cytologic findings, and the diagnostic methods used were recorded. The local ethical
Results
Four hundred patients (217 [54.2%] women and 183 [45.8%] men) were included in the study. The patients' ages ranged between 2 and 68 years (mean, 36 years). Of the lesions, 176 (44%) were vesicular, 116 (29%) were erosive, 63 (15.8%) were pustular, and 45 (11.2%) were bullous (Table I).
In addition to May-Grünwald-Giemsa staining, methylene blue and Gram staining was performed in 12 (3%) and 25 (6.3%) patients, respectively, while direct immunofluorescence examination was conducted in 28
Discussion
Tzanck smear findings in 400 patients with erosive, vesicular, bullous, and pustular skin lesions reported in this study had skin diseases which are known to be diagnosable by this method as noted in the literature.1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17
For herpes simplex and varicella-zoster infections in which acantholytic and multinucleated giant cells are diagnostic, the percentage of positivity of the Tzanck test for herpes simplex has been reported between 53.1%3 and 86%,
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Funding sources: None.
Conflicts of interest: None declared.