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A Study of Pathological and Clinical Parameters of Non-Infectious, Erythematous Papulosquamous Disorders of Skin in a Tertiary Care Hospital in Central India

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A Study of Pathological and Clinical Parameters of Non-Infectious, Erythematous Papulosquamous Disorders of Skin in a Tertiary Care Hospital in Central India Original Research Article A study of pathological and clinical parameters of non-infectious, erythematous papulosquamous disorders of skin in a tertiary care hospital in central India Bimal Patel1*, Karan S Chandraker2 1Assistant Professor, Department of Pathology, GAIMS, Bhuj, Gujrat, INDIA. 2Assistant Professor, Department of Pathology, Government Medical College, Rajnandgaon, Chattisgarh, INDIA. Email: [email protected] Abstract Background: The papulosquamous skin disorders are heterogeneous group of disorders the diagnosis of which is based on a descriptive morphology of clinical lesions characterized by scaly plaques and papules along with correlation with histomorphological features. Aims and Objectives: Study the histopathological features of the various subcategories of papulosquamous disorders along with age and sex distribution pattern and to assess the agreement of clinical and histological diagnosis. Material and methods: This was an observational study including 120 cases of all age groups and both sexes over a period of 18 months. Prediagnosed cases already on treatment or patient not willing to be part of study or denying skin biopsy were excluded. Results: Among a total of 120 cases, there was a slight male predominance with distribution in a wide range of age group. The most common lesion was psoriasis (44.1%) followed by lichen planus (21.6%), prurigo nodularis (11.6%), while pityriasis rosea, lichen amyloidosis, parapsoriasis, pityriasis rubra pilaris, and pityriasis lichenoides chronica constituted a smaller fractions (<10% each). Conclusion: Classification of these skin lesions into broad categories revealed that the psoriasiform lesions were most frequently encountered 60% followed by the lichenoid lesions. There is considerable overlap of both clinical pattern and distribution of papulosquamous skin disorders, hence a proper clinical observation and histomorphological study will give a conclusive diagnosis. Key Words: Papulosquamous lesion, scaly plaques, papules, psoriasiform, lichenoid *Address for Correspondence: Dr. Bimal Patel, Assistant Professor, Department of Pathology, GAIMS, Bhuj, Gujarat, Pin 370001. Email: [email protected] Received Date: 02/06/2019 Revised Date: 23/06/2019 Accepted Date: 11/08/2019 DOI: https://doi.org/10.26611/10151128 nutritional status and climatic conditions1,2. Eczema and Access this article online dermatitis are the most prevalent skin disorders reported from developed countries, whereas skin infections are Quick Response Code: 1 Website: predominant in developing African and Asian countries . www.medpulse.in The papulosquamous skin lesions are heterogeneous group of disorders constituting one of the largest groups of diseases seen by the dermatopathologist. The nosology of these disorders is based on a descriptive morphology of Accessed Date: clinical lesions characterized by scaly plaques and 12 August 2019 2 papules . In addition, the expertise of dermatologists and availability of the latest diagnostic facilities play a crucial 1 role .The diagnostic approach of the skin biopsies is INTRODUCTION based on the tissue reaction patterns3,4. The latter depends The prevalence of skin diseases in any region or country on the various pathological stimuli producing different depends on various factors, such as genetics, racial lesions clinically, however may show similar histological constitution, social and hygienic standards, customs, picture3. Therefore, to obtain the precise diagnosis of the How to cite this article: Bimal Patel, Karan S Chandraker. A study of pathological and clinical parameters of non-infectious, erythematous papulosquamous disorders of skin in a tertiary care hospital in central India. MedPulse International Journal of Pathology. August 2019; 11(2): 99-104. https://www.medpulse.in/Pathology/ MedPulse International Journal of Pathology, Print ISSN: 2550-7605, Online ISSN: 2636-4697, Volume 11, Issue 2, August 2019 pp 99-104 skin biopsy, it should be accompanied by all clinical fixed in 10% formalin and processed using automatic details. Epidemiological surveys are important to tissue processor. Three to 4micron sections were cut and determine the burden of dermatological disorders in an stained with hematoxylin and eosin (HandE). Other area 4.The purpose of this study was to find out the special stains like PAS and Congo red were done as pattern of papulosquamous skin diseases in patients required. The slides were reviewed with appropriate attending the Department of Dermatology, at a tertiary clinical details for final diagnosis. care hospital in central India. This study mainly includes an interpretation of two major tissue reaction patterns, the RESULTS psoriasiform and the lichenoid reactions; with The cohort in the present study comprised of 120 patients clinicopathological correlation. newly diagnosed with papulosquamous lesions. The total skin biopsies received in the department of Pathology MATERIAL AND METHODS were 378(7.26%) of which 120 skin biopsies (2.31%) The present study was an observational study, undertaken were of patients with papulosquamous diseases. Out of to study clinical and histopathological parameters in total 120 cases, Psoriasis (53 cases) was the commonest patients with papulosquamous disorders of skin. Patient lesion, followed by Lichen planus (26 cases). Details of cohort consisted of those who consented for skin biopsy the distribution of skin lesion are mentioned in Table 1. while attending Out Patient Department or in wards of There was a slight male predominance (Figure1) with sex Department of Dermatology with clinically diagnosis of distribution in various papulosquamous lesions shown in papulosquamous lesions, over a period of 18 months at a Table 1. Among various lesions, there was male tertiary care hospital in the central India. Patients who predominance in psoriasis, lichen amyloidosis, were already under treatment or did not consented for a parapsoriasis and pityriasis lichenoides chronica. Female skin biopsy or to be a part of this study were excluded predominance was seen in lichen planus and pityriasis from the study. A 4mm skin punch biopsy was taken rosea while equal sex distribution was seen in pityriasis under aseptic conditions from an active lesion, which was rubra pilaris and prurigo nodularis. Table 1: Distribution of papulosquamous skin diseases (n=120) with sex distribution Disease No. of cases (%) Males Females Psoriasis (PSO) 53 (44.2%) 33 20 Lichen planus (LP) 26 (21.7%) 12 14 Prurigo nodularis (PN) 14 (11.7%) 07 07 Pityriasis rosea (PR) 08 (6.7%) 02 06 Lichen amyloidosis (LA) 06 (5.0%) 04 02 Parapsoriasis (PP) 05 (4.1%) 03 02 Pityriasis rubra pilaris (PRP) 04 (3.3%) 02 02 Pityriasis lichenoid chronica (PLC) 04 (3.3%) 03 01 TOTAL 120 66 54 Figure 1: Sex distribution of papulosquamous lesions Figure 2: Histogram showing the the age group wise distribution of papulosquamous lesions Psoriasis was seen more commonly in 3rd, 4th and 5th decade of life. Lichen planus occurred in all age groups but was common in 2nd to 5th decade. Prurigo nodularis was seen in middle age group (31-40 years). Pityriasis rubra pilaris was seen in less than 10 years and middle age group (21-40years). Parapsoriasis and lichen amyloidosis was seen in middle and older age group (31-40years). Pityriasis rosea and pityriasis lichenoides chronic was seen in young age group in 2nd MedPulse International Journal of Pathology, Print ISSN: 2550-7605, Online ISSN: 2636-4697, Volume 11, Issue 2, August 2019 Page 100 Bimal Patel, Karan S Chandraker to 4th decades. The most common clinical presentation of patients with psoriasis was scaly plaques (98.1%) followed by papules, flat topped papules, scaly patches and thin scales. In lichen planus, papules and scaly plaques was the commonest type, followed by flat topped papules. Among prurigo nodularis, nodule was the commonest presentation followed by hyperkeratotic plaque, scaly patch and thin scales. Among pityriasis rosea, the common presentations were papular (87.5%), scaly plaque and thin scales. In lichen amyloidosis, parapsoriasis and pityriasis rubra pilaris, the most common presentation was papules. In pityriasis lichenoides chronica, scaly plaques and patches were most commonly seen. The histological features observed in each lesion are tabulated in Table 2. Table 2: Histopathological changes seen in various papulosquamous lesions PSO LP PN PR LA PP PRP PLC Histological changes (n) (n) (n) (n) (n) (n) (n) (n) Epidermal changes Hyperkeratosis 51 25 14 05 05 05 04 03 03 08 02 Parakeratosis 41 - 01 03 04 (focal) (focal) (focal) Acanthosis 34 23 13 07 02 05 04 - Orthokeratosis - - 07 - - - - - Papillomatosis - - 12 - - - - - Hypogranulosis 39 - - - - - - - Hypergranulosis - 21 13 - - - - - Granular layer thinning - 08 - - - - Spongiosis 8 - - 07 - 03 - - Psoriasiform hyperplasia 49 - 14 - - - - - Suprapapillary thinning 37 - - - - - - - Spongiform pustule 12 - - - - - - - Munro microabscessses 17 - - - - - - - Saw toothed rete ridges - 23 - - - - - - Rete ridges - elongated - - - 02 06 05 - - Rete ridges- short and broad - - - - - - 03 21 04 Degeneration of basal cells - - - 01 - - (vacuolar) (vacuolar) Max Joseph spaces - 04 - - - - - Civatte bodies - - - - - - - - Lymphocytic exocytosis - - - 08 - - - - Erythrocyte extravasation - - - - - - - 03 Follicular plugging - - - - - - 02 - Dermal changes Papillary edema 09 - 04 - 03 - - - Vascular changes 07 - 04 - - - - - 23(Band like) 06 Dermal inflammation 44 14 08 05 05 04 3(Spotty) (sparse) Pigment incontinence -
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