Histopathologic diagnostic parameters of psoriasis; a clinicopathological study
DOI:
https://doi.org/10.18203/2320-6012.ijrms20161733Keywords:
Psoriasis vulgaris, Agranulosis, ParakeratosisAbstract
Background: Psoriasis is a common inflammatory skin disorder comprised of varied histo-morphological features involving both epidermis and dermis. Further, there are psoriasiform lesions which simulate psoriasis. Hence it is mandatory to recognise psoriasis based on histopathological parameters to aid the treatment protocol.
Methods: Sixty cases of histopathologically confirmed psoriasis vulgaris and pustular psoriasis excluding psoriasiform dermatitis, reported in the Department of Pathology, over a period of 6 years were analysed. The sections were stained with hematoxylin and eosin stains and analyzed for various morphological parameters.
Results: Out of 60 cases 88.33% were psoriasis vulgaris and 11.67% were pustular psoriasis. Age incidence was high in second and fourth decades with male predominance. The commonly involved sites were upper and lower extremities. Significant histopathological parameters were parakeratosis (100%), hyperkeratosis (100%), spongiosis (91.67%), and papillomatosis (73.33%), either hypogranulosis (55%) or agranulosis (45%), and dilated and tortuous capillaries (88.33%, 43.33% respectively) in the dermis.
Conclusions: Histopathological correlation is still the gold standard tool for the diagnosis of psoriasis. In the absence of well-formed Munro microabscess and pustules of Kogoj, other epidermal features like parakeratosis, hyperkeratosis, spongiosis, papillomatosis and absent or thinned out granular layer as well as dilated and tortuous capillaries in the dermis can be considered as confirmatory evidence of psoriasis. The reduction or complete absence of granular layer was characteristic of psoriasis and reflected the pathogenesis of defective keratinocyte proliferation.
References
Weedon D, Strutton G, Rubin AI, Skin pathology 3rd edition UK: Churchill livingstoneelseveir. 2010.72-83.
Christofers E, Mroweitz U. Psoriasis. In: Freedberg IM, Eisen AZ, Wolff K, Golsmith LA, Austen KF, Fitzpatrick TB, et al. editors. Fitzpatrick’s Dermatology in General Medicine.7th edition. New York: McGraw Hill. 1999;169-93.
Camp RD. Psoriasis. In: Champion RH, Burton JL, Burns DA, Breathnach SM, editors. Rooks Textbook of Dermatology. 8th edition. Oxford: Blackwell publication. 1998;20.1-20.60.
Chandran V, Raychaudhuri SP. Geoepidemiology and environmental factors of psoriasis and psoriatic arthritis. Journal of autoimmunity. 2010;34(3):J314-21.
Kassi K, Mienwoley OA, Kouyate M, Koui S, Koussai KA. Severe skin forms of psoriasis in black Africans: Epidemiological, clinical and histological aspects related to 56 cases. Hindawipublishing corporation. 2013(2013);1-4. Article ID 561032.
Alhumidi AA. Retrospective 10 years review of 100 patients with psoriasis in the Kingdom of Saudi Arabia. American Journal of Research Communication 2013;1(8):114-20.
Manjula VD, Sreekiran S, Saril PS, Sreekanth MP. A study of psoriasis and quality of life in a tertiary care teaching hospital of kottayam, Kerala. Indian J Dermatol. 2011;56(4):403-6.
Okhandiar RP, Banerjee BN. Psoriais in the tropics: An epidemiological study. J Indian Med Assoc. 1963;41:550-6.
Kaur I, Handa S, Kumar B. Natural history of psoriasis: a study from the Indian subcontinent. J Dermatol. 1997;24:230-4.
Baker H. Psoriasis: a review. Dermatologica. 1975;150:16-25.
Bedi TR. Psoriasis in north india. Geographical variations. Dermatologica. 1977;155:310-4.
Zlotogorski A. Psoriasis of the left elbow. Australas J Dermatol. 1989;30:106.
Fatani MI, Abdulghani MM, Al-Afif KA. Psoriasis in the eastern Saudi Arabia. Saudi Medical Journal. 2002;23(2):213-17.
Grace KK, Del Rosso QJ. Drug provoked psoriasis: Is It Drug Induced or Drug Aggravated? Understanding Pathophysiology and Clinical revelance, J ClinAesthet Dermatol. 2010;3(1):32-8.
Christophers EE. Psoriasis-epidemiology and clinical spectrum. ClinExp Dermatol. 2001;26:314-20.
Mehta S, Singh N, Bhattacharya SN. A study of histopathological correlation in patients of psoriasis and psoriasiform dermatitis. Indian J Dermatol. 2009;75(1):100.
Bos JD, De Rie MA. The pathogenesis of psoriasis: Immunogical facts and speculation. Immunol Today. 1999;20:40-6.
Smyth MJ, Zachariae Co, Norihisa Y, Ortaldo JR, Hishinuma A, Masushima K. IL-8 gene expression and production in human peripheral blood lymphocytes subsets. J Immunol. 1950;146:3815-23.
Simonetti O, Lucarini G, Goteri G, Zizzi A, Biagini G, Lo Muzio, et al. VEGF if likely a key factor in the link between inflammation and angiogenesis in psoriasis: Results of an immunohistochemical study. Int J ImmunopatholPharmacol. 2006;19:751-60.
Mor F, Quintana FJ, Cohen IR, Angiogenesis- inflammation cross-talk: Vascular endothelial growth factor is secreted by activated T cells and induces Th1 polarization. J Immunol 2004;172:4618-23.
Christophers E. The immunopathology of psoriasis. Int Arch Allergy Immunol. 1996;110:199-206.
Schon MP, Boehncke WH. Psoriasis. N Engl J Med. 2005;352:1899-912.
