Abstract
The Tzanck smear is a rapid and simple technique that can be performed in the clinic or doctor’s office with minimal patient discomfort or cost. It is known to most dermatologists as a rapid test for diagnosing herpes virus infections. Its use, however, can be more widely applied, including in the diagnosis of pustular diseases of the newborn, cutaneous infections, vesiculobullous diseases, and non-melanoma skin cancers. Material is gently scraped from the base of a vesicle, blister, or pustule or directly from the lesion or tumor. Typically, the material is allowed to air dry after which it can then be stained with a variety of stains, including Giemsa, toluidine blue, and methylene blue. The Tzanck smear should not be used to replace more standard diagnostic techniques, but rather as an adjunct to the physical examination.
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References
Barr RJ. Cutaneous cytology. J Am Acad Dermatol 1984 Feb; 10 (2): 163–80
Weedon D. Skin pathology. 2nd ed. London: Churchill Livingstone, 2002: 1–1158
Barnhill RL. Textbook of dermatopathology. New York: McGraw-Hill, Medical Pub. Division, 2004: 1–1093
Lever WF, Elder DE. Lever’s histopathology of the skin. Philadelphia (PA): Lippincott-Raven, 1997: 1–1073
Gupta LK, Singhi MK. Tzanck smear: a useful diagnostic tool. Indian J Dermatol Venereol Leprol 2005; 71: 295–9
Arbesfeld DM, Thomas I. Cutaneous herpes simplex virus infections. Am Fam Physician 1991; 43 (5): 1655–64
Vincenzo R, Ruocco E. Tzanck smear, an old test for the new millennium: when and how. Int J Dermatol 1999 Nov; 38 (11): 830–4
Solomon AR, Rasmussen JE, Weiss JS. A comparison of the Tzanck smear and viral isolation in varicella and herpes zoster. Arch Dermatol 1986; 122: 282–5
Cohen PR. Tests for detecting herpes simplex virus and varicella-zoster virus infections. Dermatol Clin 1994; 12: 51–68
Schomogyi M, Wald A, Corey L. Herpes simplex virus-2 infection: an emerging disease? Infect Dis Clin North Am 1998; 12: 47–61
Goldman BD. Herpes serology for dermatologists. Arch Dermatol 2000 Sep; 136 (9): 1158–61
Cone RW, Hobson AC, Palmer J, et al. Extended duration of herpes simplex virus DNA in genital lesions detected by the polymerase chain reaction. J Infect Dis 1991; 164: 757–60
Corey L, Huang ML, Selke S, et al. Differentiation of herpes simplex virus types 1 and 2 in clinical samples by a real-time taqman PCR assay. J Med Virol 2005; 76: 350–5
Asley R, Cent A, Maggs V, et al. Inability of enzyme immunoassays to discriminate between infections with herpes simplex virus types 1 and 2. Ann Intern Med 1991; 115: 520–6
Klenk AS, Martin AG, Heffernan MP. Yeast infections: candidiasis, pityriasis (tinea) versicolor. In: Freedberg IM, Eisen AZ, Wolff K, et al., editors. Fitzpatrick’s dermatology in general medicine. New York: McGraw-Hill, 2003: 2006
Lesher Jr JL, Kight FJ. Tzanck preparation as a diagnostic aid in disseminated histoplasmosis. J Am Acad Dermatol 1986 Sep; 15 (3): 534–5
Borton LK, Wintroub BU. Disseminated cryptococcosis presenting as herpetiform lesions in a homosexual man with acquired immunodeficiency syndrome. J Am Acad Dermatol 1984; 10: 387–90
Fridlington E, Colome-Grimmer M, Kelly E, et al. Tzanck smear as a rapid diagnostic tool for disseminated cryptococcal infection. Arch Dermatol 2006 Jan; 142 (1): 25–7
Venkatesan P, Perfect J, Myers S. Evaluation and management of fungal infections in immunocompromised patients. Dermatol Ther 2005; 18 (1): 44–57
Baumgarten K, Valentine V, Garcia-Diaz J. Primary cutaneous cryptococcosis in a lung transplant recipient. South Med J 2004; 67 (7): 692–5
Hicks MJ, Flaitz CM, Cohen PR. Perioral and cutaneous umbilicated nodular lesions in acquired immunodeficiency syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997; 83: 189–91
Lafleur L, Beaty S, Colome-Grimmer MI, et al. Cryptococcal cellulitis in a patient on prednisone monotherapy for myasthenia gravis. Cutis 2004; 74 (3): 165–70
Civila ES, Bonasse J, Conti-Diaz IA, et al. Importance of the direct fresh examination in the diagnosis of cutaneous sporotrichosis. Int J Dermatol 2004 Nov; 43 (11): 808–10
Norton SA. Military dermatology textbook [online]. Available from URL: http://www.wramc.army.mil/ [Accessed 2008 Mar 1]
Ramírez JR, Agudelo S, Muskus C, et al. Diagnosis of cutaneous leishmaniasis in Colombia: the sampling site within lesions influences the sensitivity of parasitologic diagnosis. J Clin Microbiol 2000 Oct; 38 (10): 3768–73
Cotton DW, Cooper C, Barrett DF, et al. Severe atypical molluscum contagiosum infection in an immunocompromised host. Br J Dermatol 1987 Jun; 116 (6): 871–6
Van Praag MC, Van Rooij RW, Folkers E, et al. Diagnosis and treatment of pustular disorders in the neonate. Pediatr Dermatol 1997 Mar-Apr; 14 (2): 131–43
Dragomir C, Florescu L, Buhus M. Erythema toxicum neonatorum. RevMed Chir Soc Med Nat Iasi 2006 Oct-Dec; 110 (4): 797–800
Sandhu K, Kanwar AJ. Generalized bullous impetigo in a neonate. Pediatr Dermatol 2004 Nov-Dec; 21 (6): 667–9
Brown ZA, Wald A, Morrow RA, et al. Effect of serologic status and cesarean delivery on transmission rates of herpes simplex virus from mother to infant. JAMA 2003; 289 (2): 2208–9
Rudnick CM, Hoekzema GS. Neonatal herpes simplex virus infections. Am Fam Physician 2002 Mar 15; 65 (6): 1138–42
Chiou CB, Huang FY, Hsu CH, et al. Congenital cutaneous candidiasis: report of two cases. Chung-Hua Min Kuo Hsiao Erh Ko i Hsueh Hui Tsa Chih 1990 Nov-Dec; 31 (6): 396–401
Drut R, Drut RM. Congenital cutaneous candidiasis diagnosed in cytologic scrapings. Acta Cytologica 1988 Jul-Aug; 32 (4): 489–90
Colon-Fontanez F, Eichenfield LE, Krous HF, et al. Congenital Langerhans cell histiocytosis: the utility of the Tzanck test as a diagnostic screening tool. Arch Dermatol 1998 Aug; 134 (8): 1039–40
Cohen PR. Incontinentia pigmenti: clinicopathologic characteristics and differential diagnosis. Cutis 1994; 54: 161–6
Faloyin M, Levitt J, Bercowitz E, et al. All that is vesicular is not herpes: incontinentia pigmenti masquerading as herpes simples virus in a newborn. Pediatrics 2004 Aug; 114 (2): e270–2
Bakis S, Irwig L, Wood G, et al. Exfoliative cytology as a diagnostic test for basal cell carcinoma: a meta-analysis. Br J Dermatol 2004 May; 150 (5): 829–36
Memije E, De Larios NM, Waxtein LM, et al. Cytodiagnosis of cutaneous basal and squamous cell carcinoma. Int J Dermatol 2000; 39 (2): 116–20
Guarner J, Cohen C. Vulvar Paget’s disease: cytologic and immunohistologic diagnosis of a case. Acta Cytologica 1988 Sep-Oct; 32 (5): 727–30
Masukawa T, Friedrich Jr EG. Cytopathology of Paget’s disease of the vulva: diagnostic abrasive cytology. Acta Cytologica 1978 Nov-Dec; 22 (6): 476–8
Manteaux A, Cohen PR, Rapini RP. Zosteriform and epidermotrophic metastasis: report of two cases. J Dermatol Surg Oncol 1992; 18: 97–100
Cordero AA. Arnault Tzanck: his work and times. Am J Dermatopathol 1985 Apr; 7 (2): 121–3
Tzanck A. Le cytodiagnostic immediate en dermatologie. Ann Dermat et Syph 1948; 8: 205–18
Coscia-Porrazzi L, Maiello FM, Ruocco V, et al. Cytodiagnosis of oral pemphigus vulgaris. Acta Cytologica 1985 Sep-Oct; 29 (5): 746–9
Pfeiffer C. Dermatitis herpetiformis: a clinical chameleon. Hautarzt 2006; 57 (11): 1021–8; quiz 1029
Ridgway HB, Lowe NJ. Staphylococcal scalded skin syndrome in an adult with Hodgkin’s disease. Arch Dermatol 1979; 115: 589–90
Amon R, Dimond R. Toxic epidermal necrolysis: rapid differentiation between staphylococcal and drug-induced disease. Arch Dermatol 1975; 111: 1433–7
Cohen PR. Nonimmunologic acantholytic diseases: chapter 11. In: Jordon RE, editor. Atlas of bullous diseases. New York: Churchill Livingstone, 2000: 147–61
Cather JC, Hoffman L. Weepy pruritic rash in the groin. Proc (Bayl UnivMed Cent) 2007; 20 (4): 402–3
Kakar B, Kapir S, Garg VK, et al. A case of bullous Darier’s disease histologically mimicking Hailey-Hailey disease. Dermatol Online J 2007; 13 (3): 28
Cohen PR. Darier’s disease: sustained improvement following reduction mammaplasty. Cutis 2003; 72: 124–6
Stanway A. Darier disease [online]. Available from URL: http://dermnetnz.org/scaly/darier.html [Accessed 2007 Oct 13]
Oranje AP, Folkers E. The Tzanck smear: old, but still of inestimable value. Pediatr Dermatol 1998 May; 5 (2): 127–9
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Kelly, B., Shimoni, T. Reintroducing the Tzanck Smear. Am J Clin Dermatol 10, 141–152 (2009). https://doi.org/10.2165/00128071-200910030-00001
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DOI: https://doi.org/10.2165/00128071-200910030-00001