Clinico pathological correlation of inflammatory palmoplantar dermatoses in a tertiary care hospital

Bhupathi Sharanya; Rajendran Narayanan; Srikanth Shanmugam; Manobalan Karunanandhan; Shanmugasamy Kathirvelu

doi:10.18203/issn.2455-4529.IntJResDermatol20263737

Authors

Bhupathi Sharanya Department of of Dermatology Venereology and Leprosy, Mahatma Gandhi Medical College and Research Institute, SBV University, Pondicherry, India
Rajendran Narayanan Department of of Dermatology Venereology and Leprosy, Mahatma Gandhi Medical College and Research Institute, SBV University, Pondicherry, India
Srikanth Shanmugam Department of of Dermatology Venereology and Leprosy, Mahatma Gandhi Medical College and Research Institute, SBV University, Pondicherry, India
Manobalan Karunanandhan Department of of Dermatology Venereology and Leprosy, Mahatma Gandhi Medical College and Research Institute, SBV University, Pondicherry, India
Shanmugasamy Kathirvelu Department of Pathology, Mahatma Gandhi Medical College and Research Institute, SBV University, Pondicherry, India

DOI:

https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20263737

Keywords:

Clinical, Histopathology, Correlation, Palmoplantar dermatoses, Inflammatory dermatoses

Abstract

Background: Inflammatory palmoplantar dermatoses (PPD), including palmoplantar psoriasis, palmoplantar pustulosis, palmoplantar eczema, palmoplantar lichen planus, lichen nitidus often mimics each other, posing a diagnostic challenge. This study was done in an attempt to identify the clinicopathological correlation of these conditions as they have an impact on the patient's quality of life. To arrive at the degree of concordance between clinical and histopathological diagnosis of inflammatory PPD.

Methods: A 15-month study (February 2018–April 2019) was done in the Department of Dermatology, Mahatma Gandhi Medical College and Research Institute, Pondicherry. Forty patients with clinically doubtful inflammatory PPD or responding poorly to treatment underwent clinical examination and lesional skin biopsy. Clinical and histopathological diagnoses were correlated.

Results: The mean age in 40 patients was 50.60 (SD=16.46) years. Psoriasis was the most common diagnosis clinically (22, 55%) and histopathologically (23, 57.5%), followed by eczema (10, 25% and 9, 22.5%) respectively. clinicopathological concordance was observed in 18 (82%) patients with psoriasis, 6 (60%) eczema, 1 (16.7%) lichen planus and 1 (100%) patient with pustulosis. It was statistically significant in psoriasis (p=0.035), eczema (p=0.03) and pustulosis (p<0.0001), but not for lichen planus and lichen nitidus. In the non-concordant group, histopathology showed nonspecific dermatitis in 6 (15%) patients.

Conclusions: Although skin biopsy did not offer a specific diagnosis in the non-concordant group, it contributed in establishing the diagnosis in the concordant group. Hence, clinicopathological correlation is valuable for establishing an accurate diagnosis and guiding appropriate treatment.

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References

Hongal AA, Rajashekhar N, Gejje S. Palmoplantar Dermatoses- A Clinical Study of 300 Cases. J Clin Diagn Res. 2016;10(8):4-7. DOI: https://doi.org/10.7860/JCDR/2016/20818.8364

Rathoriya SG. Clinical profile of palmoplantar dermatoses in patients attending tertiary health center in central India. Int J Res Dermatol. 2018;4(4):514. DOI: https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20184221

Zemtsov A, Veitschegger M. Keratodermas. International Journal of Dermatology. 1993;32(7):493-8. DOI: https://doi.org/10.1111/j.1365-4362.1993.tb02831.x

Patel S, Zirwas M, English JC. Acquired palmoplantar keratoderma. Am J Clin Dermatol. 2007;8(1):1-11. DOI: https://doi.org/10.2165/00128071-200708010-00001

Nair P, Diwan N, Singhal R, Vora R. A prospective study of clinical profile in patients of palmoplantar dermatoses. Indian Dermatol Online J. 2017;8(5):331. DOI: https://doi.org/10.4103/idoj.IDOJ_308_16

Kumar B, Saraswat A, Kaur I. Palmoplantar lesions in psoriasis: A study of 3065 patients. Acta Dermato-Venereologica. 2002;82(3):192-5. DOI: https://doi.org/10.1080/00015550260132488

Sánchez-Pérez J, Rios Buceta L, Fraga J, García-Díez A. Lichen planus with lesions on the palms and/or soles: prevalence and clinicopathological study of 36 patients. British J Dermatol. 2000;142(2):310-4. DOI: https://doi.org/10.1046/j.1365-2133.2000.03303.x

Agarwal US, Besarwal RK, Gupta R, Agarwal P, Natalia S. Hand eczema. Indian J Dermatol. 2014;59(3):213-24. DOI: https://doi.org/10.4103/0019-5154.131372

Kang BS, Lee JD, Cho SH. A clinicopathological study of palmoplantar dermatoses. Korean J Dermatol. 2006;44(6):714-20.

Kodali S. A clinico-histopathological study of acquired palmoplantar keratoderma in a rural-based tertiary hospital. J Evol Med Dent Sci. 2014;3(30):8500-5. DOI: https://doi.org/10.14260/jemds/2014/3077

Murthy SC, Raghu TY, Suresh T. A study of palmoplantar keratodermas in South India. Int J Dermatol. 2008;47(7):762-4. DOI: https://doi.org/10.1111/j.1365-4632.2008.03529.x

Mahajan PM, Gharpuray MB, Kulkarni V. Clinical and histopathological study of palmoplantar keratoderma. Indian J Dermatol Venereol Leprol. 1994;60(5):258.

Agarwal P, Nijhawan M, Mathur DR. Clinicopathological study of hyperkeratotic lesions of palms and soles : An observational study. Int J Sci Stud. 2014;1:19-23.

Dash M, Sahu MK, Padhi T. Clinico-pathological correlation of acquired palmoplantar hyperkeratotic disorders. J Evid Based Med Healthc. 2018;5(25):1942-7. DOI: https://doi.org/10.18410/jebmh/2018/404

Khandpur S, Singhal V, Sharma VK. Palmoplantar involvement in psoriasis: A clinical study. Indian J Dermatol Venereol Leprol. 2011;77(5):625. DOI: https://doi.org/10.4103/0378-6323.84071

Chopra A, Maninder, Gill SS. Hyperkeratosis of palms and soles: clinical study. Indian J Dermatol Venereol Leprol. 1997;63(2):85-8.

Hesari KK, Naraghi ZS, Nikoo A, Ghanadan A, Sabaghi M. Palmoplantar psoriasis versus eczema: Major histopathologic clues for diagnosis. Dermatol Pract Concept. 2014;4(4):251-6.

Brunasso AMG, Puntoni M, Aberer W, Delfino C, Fancelli L, Massone C. Clinical and epidemiological comparison of patients affected by palmoplantar plaque psoriasis and palmoplantar pustulosis: a case series study. Br J Dermatol. 2013;168(6):1243-51. DOI: https://doi.org/10.1111/bjd.12223

Landis M, Boyer C, Bahrami S, Brogan B. Palmoplantar lichen planus: A rare presentation of a common disease. J Dermatol Case Rep. 2008;2(1):8-10. DOI: https://doi.org/10.3315/jdcr.2008.1008

Podder I, Mohanty S, Chandra S, Gharami RC. Isolated palmar lichen nitidus-A diagnostic challenge: First case from eastern India. Indian J Dermatol. 2015;60(3):308-9. DOI: https://doi.org/10.4103/0019-5154.156398

Park SH, Kim SW, Noh TW, Hong KC, Kang YS, Lee UH, et al. A case of palmar lichen nitidus presenting as a clinical feature of pompholyx. Ann Dermatol. 2010;22(2):235-7 DOI: https://doi.org/10.5021/ad.2010.22.2.235

Vigneshkarthik N, Ganguly S, Kuruvila S. Patch test as a diagnostic tool in hand eczema. J Clin Diagn Res. 2016;10(11):4-7. DOI: https://doi.org/10.7860/JCDR/2016/23994.8884

Trehan A, Singh K, Kanodia S, Verma AS. Contact hypersensitivity in hand eczema – A study with Indian standard series of allergens. Int Med J. 2014;1(7):6.