Comments on the Article‘‘Reintroducing theTzanck Smear’’

I read with great interest the article by Kelly and Shimoni[1]

addressing the importance of the Tzanck smear in the diagnosis

of herpes virus infections, pustular diseases of the newborn, cuta-

neous infections, vesiculobullous diseases, and non-melanoma

skin cancers. I would like to mention certain additions to this

review regarding the role of methylene blue in the diagnosis of

acantholytic cells in oral pemphigus vulgaris. I have already

published a letter in the June 2008 issue of the Journal of College

of Physicians and Surgeons Pakistan stating the importance of

the Candida smear as an adjunct for diagnosis of acantholytic

cells in oral pemphigus vulgaris.[2] The method of using me-

thylene blue to detect acantholytic cells in oral pemphigus is

elaborated here.

The smear should be taken from the oral mucosa with the

help of a cement spatula and evenly spread on a glass slide and

fixed using heat. The slide should be covered with methylene

blue for 7–10 minutes and washed with distilled water, dried,

and examined under a microscope. This method is a simple and

cost-effective technique easily performed in dental clinic prac-

tice, the results of which are straightforwardly interpreted

compared with a Papanicolaou (Pap) stain used for the detec-

tion of acantholytic cells in oral pemphigus vulgaris. An at-

tempt should be made to compare methylene blue staining with

Pap staining to detect acantholytic cells in oral pemphigus

vulgaris.

Thorakkal ShamimGovernment Taluk Head Quarters Hospital, Nilambur, India

Acknowledgments

No sources of funding were used to assist in the preparation of this

article. The author has no conflicts of interest that are directly relevant to

the content of this article.

References1. Kelly B, Shimoni T. Reintroducing the tzanck smear. Am J Clin Dermatol 2009;

10: 141-52

2. Shamim T, Varghese VI, Shameena PM, et al. Candida smear: an adjunct

for diagnosis of acantholytic cells in oral pemphigus vulgaris [letter]. J Coll

Physicians Surg Pak 2008 Jun; 18: 392

CORRESPONDENCEAm J Clin Dermatol 2010; 11 (5): 370

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