dermatopathology Dermatopathology (from Greek , ''derma'' 'skin' + , ''pathos'' 'fate, harm' + , '' -logia'' 'study of') is a joint subspecialty of dermatology and pathology or surgical pathology that focuses on the study of cutaneous diseases at a microscopic and ...

, the Tzanck test, also Tzanck smear, is scraping of an ulcer base to look for Tzanck cells. It is sometimes also called the

chickenpox Chickenpox, also known as varicella, is a highly contagious disease caused by the initial infection with varicella zoster virus (VZV). The disease results in a characteristic skin rash that forms small, itchy blisters, which eventually scab ...

skin test A skin test is a medical test in which a substance is injected into the skin. Examples * Casoni test * Corneometry * Dick test * Fernandez reaction * Frei test * Hair perforation test * Kveim test * Leishmanin skin test * Lepromin * Patch t ...

and the

herpes Herpes simplex is a viral infection caused by the herpes simplex virus. Infections are categorized based on the part of the body infected. Oral herpes involves the face or mouth. It may result in small blisters in groups often called cold s ...

skin test. It is a simple, low-cost, and rapid office based test. Tzanck cells (acantholytic cells) are found in: *

Herpes simplex Herpes simplex is a viral infection caused by the herpes simplex virus. Infections are categorized based on the part of the body infected. Oral herpes involves the face or mouth. It may result in small blisters in groups often called cold ...

* Varicella and

herpes zoster Shingles, also known as zoster or herpes zoster, is a viral disease characterized by a painful skin rash with blisters in a localized area. Typically the rash occurs in a single, wide mark either on the left or right side of the body or face. ...

Pemphigus vulgaris Pemphigus vulgaris is a rare chronic blistering skin disease and the most common form of pemphigus. Pemphigus was derived from the Greek word ''pemphix'', meaning blister. It is classified as a type II hypersensitivity reaction in which antibodies ...

Cytomegalovirus ''Cytomegalovirus'' (''CMV'') (from ''cyto-'' 'cell' via Greek - 'container' + 'big, megalo-' + -''virus'' via Latin 'poison') is a genus of viruses in the order ''Herpesvirales'', in the family ''Herpesviridae'', in the subfamily ''Betaherpe ...

Arnault Tzanck Arnault Tzanck (1886–1954) was a French physician and a pioneer of blood transfusion. During the First World War, he was a doctor in the military ambulance where he realized the vital role of the blood transfusions. Arnault Tzanck's name is atta ...

did the first cytological examinations in order to diagnose skin diseases. To diagnose

pemphigus Pemphigus ( or ) is a rare group of blistering autoimmune diseases that affect the skin and mucous membranes. The name is derived from the Greek root ''pemphix'', meaning "pustule". In pemphigus, autoantibodies form against desmoglein, whi ...

, he identified acantholytic cells, and to diagnose of herpetic infections he identified multinucleated giant cells and acantholytic cells. He extended his cytologic findings to certain skin tumors as well. Even though cytological examination can provide rapid and reliable diagnosis for many skin diseases, its use is limited to a few diseases. In endemic regions, Tzanck test is used to diagnose leishmaniasis and leprosy. For other regions, Tzanck test is mainly used to diagnose pemphigus and herpetic infections. Some clinics use biopsies even for herpetic infections. This is because the advantages of this test are not well known, and the main textbooks of dermatopathology do not include dedicated sections for cytology or Tzanck smear. A

deep learning Deep learning (also known as deep structured learning) is part of a broader family of machine learning methods based on artificial neural networks with representation learning. Learning can be supervised, semi-supervised or unsupervised. De ...

model calle
TzanckNet
has been developed to lower the experience barrier needed to use this test.

Procedure

# Unroof vesicle and scrape base w/ sterile №15 scalpel blade # Smear onto a clean glass slide # Fix w/ gentle heat or air dry # Fix w/ MeOH (Methanol) # Stain w/ Giemsa, methylene blue or Wright’s stain. # Microscopic examination using an oil immersion lens. (Look for multinucleated giant cells)Pettit, Normal Microbiota of the Skin, ATSU School of Osteopathic Medicine Arizona, Lecture Slides. Jan 2013. A modified test can be performed using proprietary agents which requires fewer steps and allows the sample to be fixed quicker.

Cytologic findings

For microscopic evaluation, samples are first scanned with low magnification objectives (X4 and X10) and then examined in detail with the high magnification objective (X100). The X4 objectives are used to select the areas to investigate in detail and to detect some ectoparasites, but the basis of the cytological diagnostic process is the X10 objective. With X10 magnification, the individual characteristics of the cells, the relationship of the cells to each other and the presence of some infection and infestation agents are evaluated. For this reason, most of the cytological examination is spent at this magnification, and most samples are diagnosed at this magnification. The key cytological findings that are observed at low magnification or, in other words, should be investigated according to the clinical characteristics of the patient are as follows: acantholytic cells, tadpole cells, granulomatous inflammation, infectious agents and increases in specific cells.

Major indications, cytologic findings and diagnostic value of Tzanck smear test

Tzanck smear examples

File:Acantholytic cell and multinucleated giant cell on a smear taken from a vesicular lesion of herpes simplex infection.jpg, Acantholytic cell and multinucleated giant cell on a smear taken from a vesicular lesion of

herpes simplex infection Herpes simplex is a viral disease, viral infection caused by the herpes simplex virus. Infections are categorized based on the part of the body infected. Herpes labialis, Oral herpes involves the face or mouth. It may result in small bliste ...

(May-Grünwald Giemsa x1000). File:Extracellular and intracellular leishmania parasites in a patient with cutaneous leishmaniasis.jpg, Extracellular and intracellular (macrophages) leishmania parasites in a patient with

cutaneous leishmaniasis Cutaneous leishmaniasis is the most common form of leishmaniasis affecting humans. It is a skin infection caused by a single-celled parasite that is transmitted by the bite of a phlebotomine sand fly. There are about thirty species of ''Leishm ...

(May-Grünwald Giemsa x1000). File:Acantholytic cells on a smear taken from a patient with pemphigus foliaceus.jpg, Acantholytic cells on a smear taken from a patient with

pemphigus foliaceus Pemphigus foliaceus is an autoimmune blistering disease ( bullous disorder) of the skin. Pemphigus foliaceus causes a characteristic inflammatory attack at the subcorneal layer of epidermis, which results in skin lesions that are scaly or crusted ...

(May-Grünwald Giemsa x1000). File:Tadpole cells on a smear taken from a patient with allergic contact dermatitis.jpg, Tadpole cells on a smear taken from a patient with allergic

contact dermatitis Contact dermatitis is a type of acute or chronic inflammation of the skin caused by exposure to chemical or physical agents. Symptoms of contact dermatitis can include itchy or dry skin, a red rash, bumps, blisters, or swelling. These rashes are ...

(May-Grünwald Giemsa x1000). File:A cluster of basaloid cells on a smear taken from a patient with basal cell carcinoma.jpg, A cluster of basaloid cells on a smear taken from a patient with

basal cell carcinoma Basal-cell carcinoma (BCC), also known as basal-cell cancer, is the most common type of skin cancer. It often appears as a painless raised area of skin, which may be shiny with small blood vessels running over it. It may also present as a raise ...

(May-Grünwald Giemsa x1000).

References

External links

Tzanck test
- medlineplus.org.
Definition of Tzanck test
- medterms.com. {{Infectious blood tests Medical tests Pathology Chickenpox