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Luo SY, Zhou KY, Wang QX, Deng LJ, Fang S. Atypical plaque psoriasis: a clinicopathological study of 20 cases. Int J Dermatol 2024; 63:1041-1047. [PMID: 38366678 DOI: 10.1111/ijd.17063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 01/05/2024] [Accepted: 01/17/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Plaque psoriasis is relatively straightforward to identify. When diagnostic concerns arise in atypical cases, a biopsy is needed. It is widely accepted that the Munro microabscess and the spongiform pustule of Kogoj are diagnostic pathological features. However, the diagnostic dilemma is likely to arise in cases without these specific pathological changes and typical clinical features. This study aimed to investigate clinical and pathological clues in distinguishing atypical plaque psoriasis from its mimics. METHODS We evaluated the clinicopathological features of 20 cases of atypical plaque psoriasis and 40 cases of psoriasis mimics as controls including pityriasis rosea (n = 10), pityriasis lichenoides chronica (n = 8), and subacute dermatitis (n = 22). RESULTS A retrospective analysis of the clinicopathological characteristics of patients with atypical plaque psoriasis and controls was performed. Pathologically, there were significant differences between the two groups in the types of parakeratosis (P = 0.046), epidermal capture of extravasated erythrocytes (P = 0.011), focal basal liquefied degeneration (P = 0.017), types of inflammatory cells (P = 0.000), and depth of inflammation (P = 0.000). Clinically, we found the presence of scales and crusts was significantly different between the two groups. CONCLUSION This study offers insight into the clinicopathological features of atypical plaque psoriasis. These differential diagnostic features, compared with its mimics, are proposed to assist the clinician in the diagnosis and treatment of atypical plaque psoriasis.
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Affiliation(s)
- Si-Yu Luo
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kai-Yi Zhou
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qin-Xiao Wang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li-Jia Deng
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Sheng Fang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Das G, Mathur M, Shrestha A, Jaiswal S, Maharjan S. Palmoplantar psoriasis: A clinicopathological correlation in a tertiary care hospital. Skin Res Technol 2024; 30:e13882. [PMID: 39099444 PMCID: PMC11298709 DOI: 10.1111/srt.13882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 06/17/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND Palmoplantar psoriasis is a clinical variant of psoriasis characterized by well-defined erythematous desquamating plaques on palms and soles, which may or may not include pustules. Hyperkeratotic lesions of palm and sole commonly include Psoriasis, Eczema and Tinea. These conditions often present with overlapping clinical and histopathological features requiring clinicohistopathological correlation for a conclusive diagnosis. The presence of munro's microabscess or spongiform pustule of kogoj differentiates psoriasis of palm and sole from other hyperkeratotic lesions of palm and sole. The objective of this study was to study the clinical and histopathological profile of palmoplantar psoriasis and correlate clinical diagnosis with histopathological diagnosis. METHOD A hospital-based, descriptive study was conducted from January 1, 2020, to December 31, 2020. Fifty-two patients were clinically diagnosed as palmoplantar psoriasis with or without involving other parts of body and routine histopathological evaluation was carried out as per standard protocols. RESULT Clinically diagnosed 52 cases of palmoplantar psoriasis showed varied histopathology with hyperkeratosis (100%), parakeratosis (100%), regular acanthosis (75%), Supra-papillary thinning (44.2%), spongiosis (65.4%), tortuous vessels in the papillary dermis (78.8%) and mixed inflammatory infiltrates (predominantly lymphocytic-100%), which were observed to be prominent findings in skin biopsies of our patients. Clinicopathological correlation was achieved in 88.5% of cases. CONCLUSION This study shows clinically diagnosed palmoplantar psoriasis with histopathological features consistent with palmoplantar psoriasis in 88.5% cases. Thus, clinically inconclusive hyperkeratotic lesions with palmoplantar psoriasis can be diagnosed with histopathological correlation improving the therapeutic intervention.
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Affiliation(s)
- Gautam Das
- Department of DermatologyCollege of Medical Sciences (COMS)BharatpurNepal
- Department of DermatologyKulhudhuffushi Regional Hospital (KRH)KulhudhuffushiMaldives
| | - Mahesh Mathur
- Department of DermatologyCollege of Medical Sciences (COMS)BharatpurNepal
| | - Ayasha Shrestha
- Department of Community MedicineCollege of Medical Sciences (COMS)BharatpurNepal
| | - Sunil Jaiswal
- Department of DermatologyCollege of Medical Sciences (COMS)BharatpurNepal
| | - Sailuja Maharjan
- Department of PathologyKulhudhuffushi Regional Hospital (KRH)KulhudhuffushiMaldives
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Quaade AS, Wang X, Sølberg JBK, McCauley BD, Thyssen JP, Becker C, Johansen JD. Inflammatory plasma signature of chronic hand eczema: Associations with aetiological and clinical subtypes. J Eur Acad Dermatol Venereol 2024; 38:1101-1111. [PMID: 38151335 DOI: 10.1111/jdv.19742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/10/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Chronic hand eczema (CHE) is a highly prevalent, heterogeneous, skin disease that encompasses different aetiological and clinical subtypes. Severe CHE without atopic dermatitis has been associated with systemic inflammation; yet it remains unknown if specific CHE subtypes leave distinct, systemic, molecular signatures. OBJECTIVES To characterize the inflammatory plasma signature of different aetiological and clinical CHE subtypes. METHODS We assessed expression levels of 266 inflammatory and cardiovascular disease risk plasma proteins as well as filaggrin gene mutation status in 51 well-characterized CHE patients without concomitant atopic dermatitis and 40 healthy controls. Plasma protein expression was compared between aetiological and clinical CHE subgroups and controls both overall and according to clinical CHE severity. Correlation analyses for biomarkers, clinical and self-reported variables were performed. RESULTS Very severe, chronic allergic contact dermatitis (ACD) on the hands was associated with a mixed Type 1/Type 2 systemic immune activation as compared with controls. Circulating levels of Type 1/Type 2 inflammatory biomarkers correlated positively with clinical disease severity among CHE patients with ACD. No biomarkers were found, that could discriminate between aetiological subtypes, for example, between ACD and irritant contact dermatitis. Hyperkeratotic CHE showed a distinct, non-atopic dermatitis-like, systemic footprint with upregulation of markers associated with Type 1 inflammation and tumour necrosis factor alpha, but not Type 2 inflammation. Increased levels of CCL19 and CXCL9/10 could discriminate hyperkeratotic CHE from both vesicular and chronic fissured CHE, whereas no difference was found between the latter two subtypes. CONCLUSION Profiling of systemic biomarkers showed potential for identifying certain CHE subtypes. Peripheral blood levels of inflammatory biomarkers were associated and correlated with the clinical disease severity of chronic ACD on the hands, underlining that this is a systemic disease. We question whether hyperkeratotic CHE should be classified as eczema.
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Affiliation(s)
- Anna Sophie Quaade
- Department of Dermatology and Allergy, The National Allergy Research Centre, Copenhagen University Hospital, Herlev-Gentofte, Hellerup, Denmark
- University of Copenhagen, Copenhagen, Denmark
| | - Xing Wang
- Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Julie B K Sølberg
- Department of Dermatology and Allergy, The National Allergy Research Centre, Copenhagen University Hospital, Herlev-Gentofte, Hellerup, Denmark
- University of Copenhagen, Copenhagen, Denmark
| | - Benjamin D McCauley
- Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Jacob P Thyssen
- University of Copenhagen, Copenhagen, Denmark
- The National Allergy Research Centre, Copenhagen University Hospital, Herlev-Gentofte, Hellerup, Denmark
| | - Christine Becker
- Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Jeanne Duus Johansen
- Department of Dermatology and Allergy, The National Allergy Research Centre, Copenhagen University Hospital, Herlev-Gentofte, Hellerup, Denmark
- University of Copenhagen, Copenhagen, Denmark
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Si W, Wang Z. What insights can be gained from optimizing the relevant research on methotrexate monotherapy versus methotrexate and apremilast combination therapy in the treatment of palmoplantar psoriasis? Indian J Dermatol Venereol Leprol 2023; 0:1-2. [PMID: 38031684 DOI: 10.25259/ijdvl_337_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/20/2023] [Indexed: 12/01/2023]
Affiliation(s)
- Weichen Si
- Health Management Center, Fengtai District Education Committee of Beijing Municipality, Beijing Municipal Education Commission, Beijing, China
| | - Zihan Wang
- Faculty of Chinese Medicine, Macao University of Science and Technology, Macau SAR, China
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Palmoplantar Psoriasis: A Clinico-Pathologic Study on a Series of 21 Cases with Emphasis on Differential Diagnosis. Diagnostics (Basel) 2022; 12:diagnostics12123071. [PMID: 36553078 PMCID: PMC9777128 DOI: 10.3390/diagnostics12123071] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/04/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
Palmoplantar psoriasis (PP) is a relatively uncommon variant of psoriasis that affects palms and soles, and that frequently shares both clinical and histologic features with chronic eczema, hyperkeratotic hand dermatitis and allergic contact dermatitis. The present study aims to characterize the histologic features of PP on a series of 21 cases. The following morphological features and their distribution were included: parakeratosis, dilated vessels in papillary dermis, psoriasiform acanthosis with elongation of rete ridges, perivascular lymphocytic infiltrate, decrease/loss of granular layer, Munro's microabscesses, spongiform pustules of Kogoj, spongiosis and lymphocytic exocytosis. The main diagnostic clues and histologic differential diagnoses are also discussed.
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Heymann WR. Differentiating hyperkeratotic palmoplantar dermatoses: Give your dermatopathologist a hand. J Am Acad Dermatol 2022; 87:752-753. [PMID: 35987395 DOI: 10.1016/j.jaad.2022.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 08/09/2022] [Indexed: 10/15/2022]
Affiliation(s)
- Warren R Heymann
- Division of Dermatology, Cooper Medical School of Rowan University, Camden, New Jersey.
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Erdem O, Leblebici C, Koku Aksu AE, Erdil D, Kara Polat A, Gürel MS. IL-36α and IL-36γ expressions in the differential diagnosis of palmoplantar psoriasis and palmoplantar eczema: A retrospective histopathologic and immunohistochemical study. J Cutan Pathol 2021; 49:42-48. [PMID: 34289144 DOI: 10.1111/cup.14105] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 07/08/2021] [Accepted: 07/12/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Diagnosing hyperkeratotic lesions on the palms and soles is often challenging for both clinicians and pathologists. Interleukin (IL)-36 cytokines play an important role in the pathogenesis of psoriasis. METHODS We retrospectively re-evaluated hematoxylin-eosin-stained biopsy specimens of 30 patients with clinically diagnosed palmoplantar psoriasis (PP) and 30 patients with palmoplantar eczema (PE), and then performed IL-36α and IL-36γ immunohistochemistry. RESULTS Among the histopathologic features, thinning of the rete ridges and vertical alternation of parakeratosis and orthokeratosis had the highest positive predictive value (PPV) in diagnosing PP (72.7% and 69.3%, respectively). Immunohistochemically, patients with PP predominantly showed diffuse or focal strong expression with IL-36α and IL-36γ staining in the upper layers of the epidermis (86.7% and 83.3%, respectively). The comparison of the mean IL-36α and IL-36γ expression scores significantly differed between PP and PE (P < .001). Among all histopathologic and immunohistochemical features, diffuse strong expression of IL-36α and IL-36γ staining had the highest PPVs in favor of a diagnosis of PP (75% and 76.7%, respectively). CONCLUSIONS Our data suggest that IL-36α and IL-36γ immunohistochemistry can be used in the differential diagnosis of PP and PE.
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Affiliation(s)
- Ozan Erdem
- Department of Dermatology and Venereology, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Cem Leblebici
- Department of Pathology, University of Health Sciences Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Ayşe Esra Koku Aksu
- Department of Dermatology and Venereology, University of Health Sciences Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Duygu Erdil
- Department of Dermatology and Venereology, University of Health Sciences Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Asude Kara Polat
- Department of Dermatology and Venereology, University of Health Sciences Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Salih Gürel
- Department of Dermatology and Venereology, Istanbul Medeniyet University Göztepe Training and Research Hospital, Istanbul, Turkey
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Çetinarslan T, Türel Ermertcan A, Temiz P. Dermoscopic clues of palmoplantar hyperkeratotic eczema and palmoplantar psoriasis: A prospective, comparative study of 90 patients. J Dermatol 2020; 47:1157-1165. [PMID: 32691449 DOI: 10.1111/1346-8138.15487] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 06/03/2020] [Indexed: 11/30/2022]
Abstract
Diagnosis can be difficult in isolated palmar and plantar lesions in patients with psoriasis and eczema. The purpose of our study is to compare the dermoscopic findings in patients with palmoplantar psoriasis and palmoplantar hyperkeratotic eczema. This prospective, comparative study included 90 patients histopathologically diagnosed with eczema or psoriasis (35 psoriasis and 55 eczema). The age range was 18-75 years. The most common vessel type was dot vessel in psoriasis. Red globular ring vessels were seen in five patients with psoriasis, but not in any with eczema (P = 0.007). The most common vascular distribution pattern was regular in psoriasis (40%). Patchy vascular pattern was significant in eczema. The most common background color was light red in psoriasis (48.6%) (P < 0.001). Brownish-orange globules were observed in 25.7% of patients with eczema and 5.7% in patients with psoriasis (P = 0.02). There is only one study in the published work about dermoscopy of palmoplantar psoriasis and eczema. In our study, yellow crusts, patchy scale distribution, patchy vascular pattern, yellow scale color, dull red background color and brownish-orange globules were significant in patients with palmoplantar eczema. On the other hand, patients with psoriasis had light red background color, regular vascular distribution pattern and white scale color. We observed globule structures with a pale center and dark peripheral rim only in patients with eczema, which was not identified in previous studies. This globule structure may be a new finding in eczema.
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Affiliation(s)
| | - Aylin Türel Ermertcan
- Departments of, Department of, Dermatology, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - Peyker Temiz
- Department of, Pathology, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
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Psoriasiform Dermatitis After Initiation of Treatment with Dupilumab for Atopic Dermatitis. Dermatitis 2019; 30:234-236. [PMID: 31094943 DOI: 10.1097/der.0000000000000481] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yazdanparast T, Yazdani K, Humbert P, Khatami A, Ahmad Nasrollahi S, Zartab H, Izadi Firouzabadi L, Firooz A. Biophysical and ultrasonographic changes in lichen planus compared with uninvolved skin. Int J Womens Dermatol 2019; 5:100-104. [PMID: 30997382 PMCID: PMC6451735 DOI: 10.1016/j.ijwd.2018.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/05/2018] [Accepted: 10/01/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Lichen planus (LP) is a chronic inflammatory disease of the skin. Currently, noninvasive techniques are used to evaluate biophysical properties of the skin in vivo. OBJECTIVE In this study, we aimed to evaluate skin biophysical properties in patients with LP and make a comparison between involved and uninvolved skin to provide a better understanding of the pathogenesis of LP. METHODS The stratum corneum hydration, transepidermal water loss, pH, erythema, melanin, sebum, friction, temperature, elasticity parameters (R0, R2, R5), and thickness and echo-density of the epidermis, dermis, and subepidermal low echogenic band were measured on lesions of classic LP in 21 patients and compared with the average of perilesional and symmetrical uninvolved skin (as control) with a paired t test. RESULTS Stratum corneum hydration (p = .002), sebum (p = .04), R0 (p = .005), and echo-density of the dermis (p = .005) were significantly lower, but pH (p = .007), melanin content (p < .001), erythema (p < .001), temperature (p = .01), thickness of dermis (p = .02), and subepidermal low echogenic band (p < .001) were significantly higher in LP lesions. CONCLUSION An evaluation of its biophysical, biomechanical, and ultrasonographic characteristics showed that the skin is an objective, noninvasive, and quantitative measuring tool that can be used to provide valuable information about skin changes in classic LP.
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Affiliation(s)
- Taraneh Yazdanparast
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
- Telemedicine Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kamran Yazdani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Philippe Humbert
- Centre d’Etudes et de Recherche sur le Tégument, INSERM UMR1098, SFR FED 4234 IBCT, University of Franche-Comté, Besançon, France
| | - Alireza Khatami
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Saman Ahmad Nasrollahi
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Zartab
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Izadi Firouzabadi
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Firooz
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
- Clinical Trial Center, Tehran University of Medical Sciences, Tehran, Iran
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