Document Type: Original Research

Authors

Dept. of Dermatopathology, Razi Skin Hospital, Tehran University of Medical Sciences, Tehran, Iran

Abstract

Background & Objectives:  Accurate differentiation of eczema and psoriasis can be difficult, especially in areas of palm and sole. This study was designed to evaluate histopathological features and identify statistically significant parameters in distinguishing palmoplantar psoriasis from eczema of these regions in patients referring to Razi Skin Hospital, Tehran, Iran. Methods: In a cross-sectional study, the patients referring to Razi Skin Hospital were subjected. Biopsies of 36 patients with palmoplantar psoriasis and 16 patients with eczema of these regions were collected from archive of pathology.  All of the biopsies were examined blind to the clinical diagnosis by four dermatopathologists separately and data collection forms were completed. Then obtained data were analyzed by SPSS software. Results: The females were more affected than males. There was no difference on involving palm and sole between psoriasis and eczema. Hypogranulosis (P<0.0001), Monro’s microabscess (P<0.0001), tortuous blood vessels in papillary dermis (P<0.0001), suprapapillary plate thinning (P=0.020), confluent parakeratosis (P=0.044) and spongiform pustule (P=0.047) were found to be statistically significant contributors to the clinicopathological concordance in cases of psoriasis. Plasma mounds (P=0.022) were significantly associated with diagnosis of eczema. Conclusion: Psoriasis was more common than eczema in the palms. Histopathologic finding like hypogranulosis, Monro’s microabscess, tortuous blood vessels in papillary dermis, suprapapillary plate thinning, confluent parakeratosis and spongiform pustule had significant relationship with psoriasis and might be useful for its diagnosis.

Keywords

1. Murphy M, Kerr P, Grant-Kels JM. The histopathologic spectrum of psoriasis. Clin Dermatol 2007;25(6):524-8.

2. Ragaz A, Ackerman AB. Evolution, maturation, and regression of lesions of psoriasis. New  observations and correlation of clinical and histologic findings. Am J Dermatopathol 1979;1:199-214.

3. Barr RJ, Young EM. Psoriasiform and related papulosquamous disorders. J Cutan Pathol  1985;12:412-25.

4. Phung OJ, Coleman CI, Kugelman L, White CM. The impact of biologic agents to treat plaque psoriasis. Conn Med 2009;73(2):79-83.

5. Jenisch S, Henseler T, Nair RP, Guo SW, Westphal E, Stuart P, et al. Linkage analysis of human leukocyte antigen (HLA) markers in familial psoriasis: strong disequilibrium effects provide evidence for a major determinant in the HLA-B/-C region. Am J Hum Genet 1998;63(1):191-9.

6. Hon KL, Yong V, Leung TF. Research statistics in Atopic Eczema: what disease is this? Ital J Pediatr 201238:26. doi:10.1186/1824-7288-38-26.

7. Ackermann AB, Boer A, Gottlieb GJ,  Bennin B. Histopathologic diagnosis of inflammatory skin diseases: An Algorithmic Method Based On Pattern Analysis. 3rd  ed. Chatham:Ardor Scribendi; 2005.

8. Cribier BJ. Psoriasis under the microscope. J Eur Acad Dermatol Venereol 2006;20:3–9.

9. Weedon D. Skin pathology. 3rd ed. Edinburgh. Edinburgh:Churchill Livingstone;2010.

10. Aydin O, Engin B, Oguz O, Ilvan S, Demirkesen C. Non-pustular palmoplantar psoriasis: is histologic differentiation from eczematous dermatitis possible? J Cutan Pathol 2008;35(2):169-73.

11. Lawton S. Assessing and treating adult patients with eczema. Nurs Stand 2009;23(43):49-56.

12. 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(1):100.

13. Cesinaro AM, Nannini N, Migaldi M, Pepe P, Maiorana A. Psoriasis vs allergic contact dermatitis in palms and soles: a quantitative histologic and immunohistochemical study. APMIS 2009;117(8):629-34.