1. Presenter: Dr. Golla Akshay
1st year post graduate student
Department of Pathology
A CLINICOPATHOLOGICAL CORRELATION OF
PSORIASIFORM DERMATITIS IN A TERTIARY CARE CENTRE.
Guide: Dr. B. P. Bommanahalli
Professor & HOD
Department of Pathology
Co Guide: Dr. Veeresh.V. Dyavannanavar
Associate Professor
Department of Dermatology
2. Need for the Study
Psoriasiform dermatitis includes wide variety of conditions that pose a diagnostic
challenge for dermatologists and pathologists.1
Skin biopsy aids in arriving at a specific diagnosis where clinical diagnosis is of
ambiguity.1
3. Need for the Study
Psoriasiform dermatitis represent a broad spectrum of inflammatory conditions, with several
major forms represented by psoriasis as the prototype of this category, followed by Pustular
psoriasis, Reiter’s syndrome, Pityriasis rubra pilaris, Lichen simplex chronicus and large-
plaques parapsoriasis. 2
Because of their complexity and frequent overlapping of the microscopical features, they
create a diagnostic challenge, both clinically and histopathologically.2
4. Need for the Study
• Psoriasis is an autoimmune chronic inflammatory T-cell mediated
systemic disease manifesting on the skin, nails and joints affecting 2 –
3% of the population.3
• Histopathological changes may vary according to the stage, clinical
presentation and previous treatments, if any taken. 3
5. Need for the Study
The characteristic histopathological features of psoriasiform reaction
comprise extensive hyperkeratosis, with horizontally confluent but vertically
intermittent parakeratosis, which alternate with orthokeratosis, thin granular
layer, with relative frequent mitoses, uniform elongated and fused rete ridges,
edematous superficial papillary dermis, with dilated capillaries, perivascular
lymphocytic infiltrate, Munro’s microabscesses, and spongiform pustules of
Kogoj.2
6. Need for the Study
• Though not completely curable, the modern medicine can help in
bringing down the severity of the disease if diagnosed correctly and
thus uplift the sufferers.3
• Histopathologic analysis of skin biopsy can be useful to confirm the
diagnosis and clinically correlate the signs and symptoms.4
7. Need for the Study
• Clinicopathologic correlation helps in better understanding of the
pathophysiology of this disease.4
• Hence this study is undertaken to evaluate the histopathological
findings in various psoriasifirom dermatitis and also to highlight the
diagnostic accuracy and the clinicopathological correlation.
8. REVIEW OF LITERATURE
• Psoriasiform term implies that a lesion clinically or histologically
mimics psoriasis. 5
• It is essential to follow a systematic approach and use appropriate
clinicopathological correlation to arrive at a diagnosis.5
9. REVIEW OF LITERATURE
• Although the general histological features are shared by most of the inflammatory
dermatitis, there are specific microscopical aspects which are pathognomonic for
each major form of this disease, which highlight the differences between all
inflammatory dermatitis in terms of clinical appearance, pathogenesis and
histopathological characteristics related to the quality of scales and the distribution
and composition of the inflammatory infiltrate.6
10. REVIEW OF LITERATURE
• Okhandiar et al.7 collected a comprehensive data from various medical colleges
and found that the incidence of psoriasis among the patients ranged between
0.44% and 2.2% with overall incidence of 1.02%.
• The ratio of male to female (2.46:1) was high. Highest incidence was noted in the
age group of 20-39 years and the mean age of onset in males and females was
comparable.7
11. REVIEW OF LITERATURE
• Study conducted by Suseelan A et al. 3 on 75 patients, evaluated histopathological
findings of psoriasiform dermatitis, various histopathological parameters enlisted
were: parakeratosis, hypogranulosis, acanthosis, regular elongation of rete ridges,
mitosis extending beyond the basal layer of epidermis, pallor in the upper layers of
epidermis, suprapapillary thinning, dermal edema, dilated and tortuous blood
vessels in the papillary dermis have been evaluated as significant determinants to
the diagnosis of psoriasis even in the absence of Munro micro abscess and
spongiform pustule of Kogoj.3
12. AIMS AND OBJECTIVES OF STUDY
1. To assess the histopathological features of psoriasiform dermatitis.
2. To assess the characteristic microscopical differences between the
various forms of psoriasiform dermatitis.
3. To study the association of clinical diagnosis with histopathological
diagnosis of psoriasiform dermatitis.
13. Materials And Methods
Source of data:
The patients presenting with psoriasiform lesions, visiting the Dermatology
Department at Gadag Institute Of Medical Sciences, Gadag and those patients
further subjected to skin biopsy for evaluation will be included in the study.
14. Materials and Methods
• Methods of Collection of Data:
• The patients with psoriasiform lesions presenting to dermatology department will
be thoroughly evaluated for skin lesions.
• Their clinical findings, past history and treatment history will be recorded. After
obtaining consent, the patients who are further subjected to skin biopsy of the
representative lesions will be included in the study.
15. Materials and Methods
• The skin biopsy tissue thus obtained will be fixed in 10% formalin and sent to
histopathology laboratory.
• Tissue will be processed to prepare paraffin sections, and will be stained by
Hematoxylin and Eosin.
• The stained tissue sections will be microscopically examined for evaluating the
changes in epidermis, dermis and to arrive at specific histopathological diagnosis.
• Special stains will be applied wherever necessary.
16. Materials and Methods
A. Study type: Observational study.
B. Study period: 2 years from May 2023 to April 2025.
C. Place of study: Department of Pathology, Gadag Institute of Medical Sciences,
Gadag.
D. Sample size: 73 Patients.
E. Study design: Hospital based cross-sectional study.
17. Materials and Methods
The calculation was done by using the formula:
• n = 4 pq
L2
• n = 4x3x97 = 72.75 = 73
42
Where;
p is prevalence = 3.3
q = 1- p
L is absolute error = ±4
18. Inclusion and Exclusion Criteria
• Inclusion Criteria:
1. All patients with psoriasiform lesions and who undergo subsequent skin biopsy
will be included in the study.
• Exclusion Criteria:
1. Patients who are on topical or systemic steroids therapy for the last 30 days.
2. Inadequate biopsy specimens (punch biopsy specimens with inadequate sampling
of epidermis or dermis, specimens with poorly preserved morphology)
3. Non consenting patients.
19. Methodology
This is a hospital based prospective, cross–sectional study which will be undertaken
in the department of Pathology.
After obtaining approval and clearance from the institutional ethics committee, the
patients fulfilling the inclusion criteria will be enrolled for the study after obtaining
written informed consent.
20. Methodology
• A total of 73 cases presenting with a clinical diagnosis of psoriasis or psoriasiform
dermatitis will be selected.
• Relevant clinical history, treatment history and physical examination findings will
be noted. The biopsies will be taken after obtaining written informed consent.
• The tissue will be processed in histopathology laboratory and stained with
Hematoxylin and Eosin.
21. Haematoxylin and Eosin staining
1. Deparaffinize the sections with xylene for 5 minutes.
2. Treat with absolute alcohol: 2 changes of 5 minutes each.
3. Wash with water.
4. Stain in Harris Haematoxylin for 5 minutes. Treat with 1% acid alcohol by 1
quick dip.
5. Wash in running tap water for blueing - 5 to 10 minutes.
6. Stain in 1% aqueous eosin for 2 minutes.
7. Water wash.
8. Dehydrate with alcohol 2 changes.
9. Treat with xylene 2 changes.
10. Mount with DPX (distyrene plasticizer xylene).
22. Methodology
• A detailed study of the histopathological features will be performed.
• The epidermis will be evaluated for changes such as hyperkeratosis, parakeratosis,
orthokeratosis, hypogranulosis, Munro’s microabscess and spongiform pustules of
Kogoj.
• The dermis will be examined for changes such as elongation of rete ridges,
papillary dermal edema and patterns of inflammatory infiltrate.
23. Methodology
• Sampling technique: Simple random sampling by lottery method.
• Sampling method: According to hospital dermatology clinic data in our department we
receive around 4 to 5 samples of punch biopsy of skin monthly. From that average of 3
samples will be selected by lottery method. In this method the samples of population are
numbered on separate paper slips of identical size, shape and color. These paper slips are
folded and mixed in a box and random selection is made. This process is repeated until we
achieve the desired sample size of 73.
24. • STATISTICAL ANALYSIS: The data will be entered in MS Excel
and analyzed using the statistical software SPSSV22 and the data will
be obtained in frequencies, percentages, mean and standard deviation
for quantitative data and for association will be calculated using chi
square test.
• P value < 0.05 will be considered as statistical significant value.
25. REFERENCES
1. Bhargava S, Mathur R. Psoriasiform dermatoses: the diagnostic challenges
revisited. J. Krishna. Inst. Med. Sci. Univ. 2022;11(2):92-104.
2. Lever WF. Non infectious erythematosis, popular and squamous diseases. In
Elder DE, Elenitsas R, Johnson BL, Murphy GF, Xu X. Lever’s histopathology of
skin. Philadelphia: Wolter’s Kluwer; 2009. p174-84.
3. Suseelan A, Mohandas L, George V, Ramadevi AV, Simi SM, Vasudevan S et al.
A clinicopathological study of psoriasiform dermatitis. Int. j. appl.
res.2021;7(10):13-6.
4. Murphy M, Kerr P, Grant-Kels JM. The histopathologic spectrum of psoriasis.
Clin Dermatol. 2007 Nov-Dec;25(6):524-8.
26. 5. Kalpana K. A detailed study of histomorphological spectrum of psoriasiform
dermatitis. Indian J Pathol Res Pract. 2017; 6(2):410-4.
6. Balan R, Grigoraş A, Popovici D, Amălinei C. The histopathological landscape
of the major psoriasiform dermatoses. Arch Clin Cases. 2021 Oct 27;6(3):59-68.
7. Okhandiar RP, Banerjee BN. Psoriasis in the tropics: An epidemiological survey.
J Indian Med Assoc. 1963;41:550-6.
