Cytomorphological Spectrum and Diagnostic Utility of Tzanck Smear Cytology in Vesiculobullous Skin Lesions: A Cross-Sectional Study From a Tertiary Care Center in Eastern Uttar Pradesh, India

Background Tzanck smear cytology is a simple, rapid, cost-effective, and minimally invasive diagnostic tool used in evaluating vesiculobullous skin lesions. It is beneficial in the early diagnosis of herpetic infections and autoimmune blistering diseases such as pemphigus vulgaris, where acantholytic (Tzanck) cells may be observed. However, interpretation must be made in conjunction with clinical history and examination findings. Aim This study aims to assess the diagnostic utility and limitations of Tzanck smear cytology in the evaluation of vesiculobullous skin disorders in correlation with clinical findings, with a focus on its relevance in the Indian population. A limited amount of research has been conducted in Indian literature regarding the utility and limitations of Tzanck smear cytology in treating different types of dermatological disorders. Methods A cross-sectional study was conducted at the Dermatology outpatient department and the Pathology department of a newly established tertiary care center in Eastern Uttar Pradesh, India. Over a six-month period (June 2023-November 2023), all patients presenting with at least one vesiculobullous skin lesion underwent Tzanck smear examination. Smears were prepared using standard techniques, stained with May-Grünwald Giemsa (MGG), and evaluated microscopically. Cytological findings were correlated with patient history and clinical diagnosis. Results A total of 30 patients were included in the study. Tzanck smears revealed diagnostic findings in 10 cases, with pemphigus vulgaris being the most common (n = 8), followed by herpetic infections (n = 2). The remaining 20 cases showed non-specific or negative findings and required further evaluation through histopathological biopsy. Conclusion Tzanck smear cytology can expedite clinical decision-making, reduce the need for invasive procedures, and be effectively used in conjunction with histopathological evaluation, particularly in resource-limited settings. Tzanck smear can be an effective tool as a preliminary step in evaluating vesiculobullous lesions of skin in busy tertiary care centers to filter out benign diagnoses, specifically bullous pemphigoid, as well as herpes vesicles.