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Year 2020

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Chandrika and Tadepalli: A clinicopathological study of non-infectious papulo - squamous lesions of skin


Introduction

Papulo - squamous diseases comprise the largest conglomerate of skin diseases seen by the Dermatologist. The frequency of occurrence of Papulo - squamous diseases is high.1 It is feasible to consider them in a group because all of them are characterized by similar morphological characteristics. The morphology is characterized by primary lesion most commonly a papule, usually erythematous, with a variable degree of scaling on the surface and plaques through coalescing of primary lesions. This amounts a lot of confusion and hence a definitive histopathological diagnosis goes a long way in treatment of such diseases. 2

The interpretation of many skin biopsies requires identification and interpretation of two different morphological features – the tissue reaction pattern and pattern of inflammation. Although histopathological study is considered the gold standard in diagnosing dermatological lesions, it has its own limitations and very often a definite specific diagnosis is not possible. In these cases correlation of histopathological findings with clinical findings will make a diagnosis possible.3

The present study is a prospective study done to evaluate the role of histopathology in the diagnosis of Papulo squamous lesions of skin and its correlation with clinical signs and symptoms. The major non infectious Papulo squamous lesions included in the study are psoriasis, parapsoriasis, lichen planus, lichen nitidus, lichen striatus, Pityriasis rosea, and Pityriasis rubra pilaris.

Materials and Methods

The present study was conducted in department of pathology. Various non infectious Papulo - squamous lesions in relation to age and sex were evaluated. The incidence of various types of non infectious Papulo - squamous lesions were evaluated. Histopathological features of various non infectious Papulo - squamous lesions were studied. Clinico - pathological correlation of non infectious Papulo - squamous lesions were analysed and compared with other similar studies.

Results

Table 1

Non- infectiousPapulo - squamous lesions in comparison to total skin biopsies

Lesion No. of Cases Percentage (%)
Non Infectious Papulo - squamous Lesions 65 33.85
Other Skin Lesions 127 66.15
Total Skin Biopsies 192 100
Table 2

Distributionof Non Infectious Papulo - squamous Lesions

Disease No. of Cases Percentage (%)
Lichen Planus 42 64.6
Psoriasis 16 24.6
Pityriasis Rosea 04 6.2
Pityriasis Rubra Pilaris 02 3.1
Lichen Nitidus 01 1.5
Total 65 100
Table 3

Gender DistributionOf Non-Infectious Papulo - squamous Lesions

Disease Male Female
Lichen Planus 14 28
Psoriasis 10 06
Pityriasis Rosea 02 02
Pityriasis Rubra Pilaris 01 01
Lichen Nitidus 01 0
Total 28 37
Table 4

Clinicopathological correlation

Histopathologicaldiagnosis Clinical Diagnosis Clinically Different Diagnosis
Lichen Planus 38 04
Psoriasis 15 01
Pityriasis Rosea 04 0
Pityriasis Rubra Pilaris 02 0
Lichen Nitidus 01 0
Total 60 05

Out of 65 cases, 60 cases (92%) cases showed positive clinicopathological correlation and 5 cases (8%) showed clinicopathological discrepancies(Table 1). Histopathologically most cases of lichen planus showed irregular acanthosis, wedge shaped hypergranulosis in the epidermis and band like lymphocytic infiltrate in the superficial dermis(Figure 1). Civatte bodies were noted in 23.80% of cases and Max Joseph spaces were seen in 11.90%(Table 2)(Table 3).

Histopathologically, common features were in psoriasis: Hyperkeratotic epidermis with psoriasiform hyperplasia, elongated rete ridges with suprapapillary thinning. Munro Microabscesses were seen in 25% cases .Scattered inflammatory cells and edema were also noted in 12 and 8 cases respectively (Figure 2, Figure 3). All four cases of Pityriasis Rosea showed epidermal acanthosis and perivascular dermal infiltrates. Slight spongiosis and Extravasated erythrocytes in the dermis extending up to epidermis were seen in 3 cases (Table 4).

Figure 1

Clinical picture of lichenplanus showing well defined hyperpigmented plaques with violaceous halo.

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Figure 2

HYPERTROPHIC LICHEN PLANUS – showing hyperkeratosis, hypergranulosis and papillomatosis with band like Lymphocytic infiltrate in dermo-epidermal junction (H&E stain: 400x).

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Figure 3

PSORIASIS VULGARIS-Munro microabscess in parakeratotic layer (H&E stain:400x).

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Discussion

In the present study Lichen Planus (64.6 %) was the most common lesion followed by Psoriasis (24.6 %), Pityriasis Rosea (6.2%), and Pityriasis Rubra Pilaris (3.1 %). One case of Lichen Nitidus was noted in the present study. Parapsoriasis and Lichen striatus were not noted in the present study. Other studies shows Lichen Planus as significantly more common than other Papulo - squamous lesions.4, 5, 6, 7, 8 In our study most common age group for lichen planus was 31-40 years which was comparable with the study done by D’Costa and Bharambe. In the present study 22 cases (34 %) were clinically diagnosed correctly, 38 cases (58%) were differentially diagnosed and 5 cases (8 %) had different clinical diagnosis. Clinical, differential and histopathological diagnosis was same in 92 % of cases and different in 8% of cases which was comparable with the study done by D’costa & Bharambe (2010).

In the present study 6(37.5%) cases were diagnosed clinically as psoriasis without any differential diagnosis and in 9(56.25%) cases psoriasis was among the differential diagnosis.

Conclusion

Separation of each entity is important because the treatment and prognosis for each tends to be disease specific. Most of these cases have characteristic Histopathological features that confirm the diagnosis.

However nonspecific and overlapping of Histopathological features are not so uncommon. In those cases clinical correlation is very important to make final diagnosis. Hence a combination of proper clinical observation, history and histopathological study will give a conclusive diagnosis.

Source of Funding

None.

Conflict of Interest

None.

References

1 

Sushma Hosamane Clinicopathological Study of Non-Infectious Erythaematous Papulosquamous Skin DiseasesJ Clin Diagn Res2016106EC19

2 

E David Elder Rosalie Elenitsas L Bernett Johnson F George Murphy Introduction to dermatopathologic diagnosis in Lever’s Histopathology of the Skin9th Edn.2005

3 

Grace D′ Costa BhavanaM Bharambe Spectrum of non-infectious erythematous, papular and squamous lesions of the skinIndian J Dermatol2010553225

4 

Gillian Weston Michael Payette Update on lichen planus and its clinical variantsInt J Women's Dermatol201511409

5 

Farzam Gorouhi Parastoo Davari Nasim Fazel Cutaneous and Mucosal Lichen Planus: A Comprehensive Review of Clinical Subtypes, Risk Factors, Diagnosis, and PrognosisScientific World J20142014

6 

Giovanni Luigi Capella Aldo Fabrizio Finzi Psoriasis and other papulosquamous diseases in infants and childrenClin Dermatol20001867019

7 

C H Cotton W L Tom Psoriasis and Other Papulosquamous Skin Disorders. InTherapy in Pediatric DermatologySpringerCham20173350

8 

M Di D F Wan S Q Xu Y Lu J M Shen W Y Zhu Papulosquamous diseases. InAtlas of Skin Disorders Springer2018105126



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