Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore s18

SYNOPSIS

Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka.

“CLINICOPATHOLOGICAL STUDY OF NON INFECTIOUS ERYTHEMATOUS,

PAPULOSQUAMOUS SKIN DISEASES”

Name of the candidate : Dr. Sushma.H.M

Guide : Dr. Umaru.N

Course and Subject : M.D. (Pathology)

Department of Pathology,

A J Institute of Medical Sciences,

Kuntikana, Mangalore. 2012

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

1 Name of the candidate and DR SUSHMA.H.M,

address(in block letters) POST GRADUATE RESIDENT,(MD)

DEPARTMENT OF PATHOLOGY,

A.J.INSTITUTE OF MEDICAL SCIENCES,

MANGALORE. 2 Name of the Institution A.J. INSTITUTE OF MEDICAL SCIENCES

MANGALORE. 3 Course of study and MD PATHOLOGY.

Subject 4 Date of admission to course 22/05/2012

5 Title of the Topic

CLINICOPATHOLOGICAL STUDY OF NON INFECTIOUS

2 ERYTHEMATOUS, PAPULOSQUAMOUS SKIN DISEASES

6 BRIEF RESUME OF THE INTENDED WORK:

6.1 Need for the study

The skin, which is the largest organ in the body, has a limited number of

reaction patterns with which it can respond to pathological stimuli 1 .

Therefore, clinically different lesions may show similar histological

patterns. So it is necessary to have a detailed history along with the

specimen of skin biopsy, age, sex, site of biopsy, duration of lesion, duration

of local and systemic therapy, as well as possible differential diagnosis.

Although histopathological study is considered the gold standard in

diagnosing dermatological lesions, it has its 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 2 .

Papulosquamous diseases compose the largest conglomerate of skin diseases

seen by the dermatologist. All these lesions are usually characterized by

scaling papules and plaques. This amounts to lot of confusion and hence, a

3 definitive histopathological diagnosis goes a long way in treatment of such diseases 3 .

Few papulosquamous conditions, like psoriasis mimic diverse dermatological conditions as they present with numerous clinical variants and pose to be a diagnostic dilemma for the clinician 4 . Some conditions

like Lichen planus are well defined in general population, however their pathogenesis is not exactly defined 5 . In such diseases studies are lacking in India and hence a histopathological study for clinical correlation will help the dermatologist in instituting proper therapy and can vary the prognosis significantly.

6.2 Review of Literature

The frequency of occurrence of erythematous, papulosquamous diseases is high. It is feasible to consider them in a group because all of them are characterized by similar morphological characteristics.

Psoriasis, the word derived from ‘Psora’ in Greek which means ‘the itch’, is a common, papulosquamous disorder affecting about 1.5-3% of the world’s population, causing significant morbidity6. Both genetic and environmental factors are thought to play a role in the initiation and progression of disease. The presence of a well-defined margin and a silvery white scale, over a glossy homogenous membrane, is clinically diagnostic of psoriasis7. Although the etiology of psoriasis is unknown, there is evidence of a complex

4 interaction between altered keratinocyte proliferation, differentiation, inflammation and immune dysregulation8.

Lichen planus is a common inflammatory skin disease presenting with characteristic violaceous polygonal pruritic papules. Etiology is unknown, but immunologic mechanisms triggered by poorly defined antigenic stimulations plays a pivotal role in the pathogenesis9, 10. Its prevalence is 1% to 2 % in general population. There is a strong

preference for the female sex. Sousa and Rosa 11 surveyed 79 oral lichen planus cases diagnosed between 1974 and 2003, and found that women are nearly four times more affected by this condition than men. A biopsy for histopathology was recommended to confirm the clinical diagnosis and mainly to exclude epithelial atypia and signs of malignancy11.

Lichen nitidus and Lichen Striatus represent variants of Lichen planus and are seen more commonly in blacks and in infants respectively9, 10 .

Pityriasis rosea is a common benign self-limited papulosquamous disease. In a study conducted by Chuh et al, Pityriasis rosea was considered universal and its incidence was around 0.68 per 100 dermatological patients. The male: female ratio was around 1:1.43. The community-based incidence was reported to be 172.2 per 1,00,000 person years12.

Pityriasis rubra pilaris is a chronic papulosquamous skin disease of unknown etiology clinically characterized by symmetrical small follicular papules, scaly yellow pink patches and palmoplantar hyperkeratosis. In a study conducted by Sehgalthe incidence was 1 in

50,000 in India 13. A bimodal and trimodal age distribution had been recorded with peak incidence in 1st, 2nd and 6th decade of life. Microscopic pathology and its variations had

5 been clearly defined, emphasizing its role in supplementing clinical diagnosis13.

Erythema annulare centrifugum (EAC) is classified as one of the figurate or gyrate

erythemas. First described by Darier in 1916, it is characterized by a scaling or non-scaling,

nonpruritic, annular or arcuate, erythematous eruption.Since its initial description in 1916,

the term erythema annulare centrifugum has grown to include several histologic and clinical

variants.

6.3 Objectives of the study

1. To study the histopathological findings in erythematous, papulosquamous

lesions of the skin in detail.

2. To correlate the clinical findings with histopathological features of

erythematous, papulosquamous lesions of the skin.

7 Material and methods:

7.1 Source of data.

The study includes clinically diagnosed / suspected and untreated cases of

erythematous, papulosquamous skin lesions attending the Department of

6 Dermatology, A.J Institute of Medical Sciences, Mangalore.

Study period : July 2012 to August 2014

Sample study : Intended to study a minimum of 150 cases

7.2 Method of collection of data ( including sampling procedure, if any)

Biopsy of clinically diagnosed/suspected cases of erythematous, papulosquamous lesions will be performed in the Department of

Dermatology and sent to the Department of Pathology in 10 % formalin. The specimen obtained will be subjected for tissue processing after fixation.

Tissue sections will be prepared from paraffin block and stained with haematoxylin and eosin followed by microscopic examination.

Inclusion criteria: Cases included in the study are those with features of non-infectious erythematous papulosquamous skin disorders.

Exclusion criteria: Skin disorders with infective etiology and other skin lesions which are not papulosquamous disorders are excluded.

Plan for data analysis:

The data will be collected and statistically comparative study will be done.

7 Informed consent :

Informed consent of the patient for the procedure will be obtained by the

dermatologists when biopsy is done.

Identity of the patient will be kept confidential.

7.3 Does the study require any investigations or interventions to be

conducted on patients or other humans or animals? If so, please describe

briefly? – No.

7.4 Has ethical clearance been obtained from your institution:

Yes. 8 LIST OF REFERENCES

1. Grace D’Costa, Bhavana M Bharambe. Spectrum of non-infectious

erythematous, papulosquamous lesions of the skin. Indian J Dermatol 2010

July-Sep; 55(3):225-228.

2.David.E.Elder,Rosalie Elenitsas, Bernett.L.Johnson,Jr., George.F.Murphy.

Introduction to dermatopathologic diagnosis in Lever’s Histopathology of

the Skin. Ninth edition 2005; Lippincott Wiliams and Wilkins :1

3. Mohammad Younas and Anwar ul Haque. Spectrum of Histopathological

Features in Non-Infectious Erythematous and Papulosquamous diseases.

8 International Journal of Pathology;2004;2(1):24-30

4.Mehta S, Singal A, Singh N, Bhattacharya SN. A study of clinicohistopathological correlation in patients of psoriasis and psoriasiform dermatitis. Indian J Dermatol Venereol

Leprol 2009; 75:100.

5. Lichen Planus-a Clinico-histopathological. Indian J Dermatol Venereol Leprol

2000;66:193-5

6. Krueger GG, Duvic M. Epidemiology of psoriasis: Clinical issues. J Invest Dermatol

1994; 102:14-8.

7. Camp RD. Psoriasis. In: Champion RH, Burton JL, Burns DA, Breathnach SM, editors.

Rooks textbook of dermatology. 6thed. Oxford: Blackwell Publication; 1998: 1589-651.

8. Regan W. Nevoid psoriasis? Unilateral psoriasis? Int J Dermat2006 ; 45:1001-2

9. Daoud MS, Pittelkow MR. lichen nitidus. In: Freedberg IM, Eisen AZ, Wolff K, Austen

KF, Goldsmith LA, Katz SI. Fitzpatrick’s dermatology in general medicine. 6th ed. New

York : McGraw Hill; 2003: 478-80

10. Hauber K, Rose C, Brocker EB, Hamm H. European Journal of Dermatology 2000 ; 10:

11. Sousa FACG, Rosa LEB. Brazilian Journal of Otolaryngology 2008; 74(2) : 284-92

12. Chuh AA, Albert Lee , Vijay Zawar . Pityriasis Rosea- an update. Indian J Dermatol

Venereol Leprol Sep-Oct 2005 ; Vol 71, Issue 5: 311-314.

13. Sehgal VN, Srivastava G, Dogra S . Indian J Dermatol Venereol Leprol 2008 ; Vol 74 :

311-21

9 9 Signature of candidate

10 Remarks of the guide .

10 11 Name & Designation of

(in block letters) Dr. UMARU.NM.B.B.S, MD., 11.1 Guide PROFESSOR AND HOD,

A.J. INSTITUTE OF MEDICAL SCIENCES,

MANGALORE.

11.2 Signature

11.3 Head of Dr. UMARU.NM.B.B.S, MD., Department PROFESSOR AND HOD,

A.J. INSTITUTE OF MEDICAL SCIENCES,

MANGALORE

11.4 Signature

11 12 12.1 Remarks of the Chairman and Principal

12.2 Signature

12 PROFORMA

PATIENT DETAILS:

Occupation:

Address:

Hospital Number:

Histopathology Number :

CLINICAL DETAILS:

CLINICAL DIAGNOSIS :

HISTOPATHOLOGICAL FINDINGS :

HISTOPATHOLOGICAL DIAGNOSIS :