The value of Tzanck smear test in diagnosis of erosive, vesicular, bullous, and pustular skin lesions
Accepted 15 July 2008. published online 17 October 2008.
Refers to article:
Commentary: Heading the wrong way: The disappearing Tzanck smear
, 17 October 2008
Thomas D. Horn
Journal of the American Academy of Dermatology
December 2008 (Vol. 59, Issue 6, Pages 965-966) Full Text |
Full-Text PDF (56 KB)
Background
Tzanck smear is generally used for the diagnosis of the pemphigus group of autoimmune bullous diseases and mucocutaneous herpesvirus infections. There are only a few studies in the literature investigating its diagnostic value.
Objectives
We aimed to investigate Tzanck smear findings and to determine the diagnostic value of this test in moist (erosive, vesicular, bullous, and pustular) skin lesions. We also aimed to develop an algorithmic approach for the diagnosis of these types of skin lesions according to the Tzanck smear findings.
Methods
Samples were stained with May-Grünwald-Giemsa and evaluated by the same dermatologist. In some patients, methylene blue and Gram staining or direct immunofluorescence examinations were additionally performed. In all of the study cases, after the evaluation of clinical and laboratory findings (including, when appropriate, potassium hydroxide examination; viral serology; bacterial and fungal cultures; histopathology; direct and indirect immunofluorescence; patch testing), the definite diagnosis was established. We also determined the sensitivity and the specificity of certain Tzanck smear findings.
Results
Tzanck smear was performed in a total of 400 patients with moist skin lesions. The sensitivities of multinucleated giant cells and acantholytic cells in herpetic infections, dyskeratotic acantholytic cells and cocci in bullous impetigo, pseudohyphae in candidiasis, acantholytic cells in pemphigus and more than 10 tadpole cells (magnification ×100) in spongiotic dermatitis were 84.7%, 92%, 100%, 100%, and 81.5%, respectively.
Limitations
Because Tzanck smears were evaluated by the same dermatologist, no comment could be made regarding the interobserver reliability of this test and how the level of experience with this technique might affect the results. Also, the sensitivity and the specificity of Tzanck smear test findings for certain diseases could not be calculated because of an insufficient number of patients.
Conclusion
The Tzanck smear test is an inexpensive, useful, and an easy diagnostic tool for certain skin diseases.
aDepartment of Dermatology, Başkent University Faculty of Medicine, Adana Hospital, Adana, Turkey
bDepartment of Dermatology, Başkent University Faculty of Medicine, Ankara Hospital, Ankara, Turkey
Reprint requests: Deniz Seçkin, MD, Başkent University Faculty of Medicine, Department of Dermatology, 5. sokak No. 48, Bahcelievler, 06490, Ankara, Turkey.
ABSTRACT