Morphological Patterns of Cutaneous Papulosquamous LesionsA Diagnostic Dilemma

Abstract

Introduction: Papulosquamous skin lesions are characterised by a unique morphologic feature called as superficial cutaneous reactive unit with the basic patterns of predominantly lichenoid and psoriasiform dermatitis. It constitutes largest conglomerate of skin diseases posing diagnostic dilemma to both dermatologist and pathologist. Although characterised by typical scaly papules, a lot of similarity in both clinical presentation and distribution of papulosquamous skin disorders makes clinical diagnosis more difficult. The diagnostic specificity with overlapping features will be achieved by correlating the gold standard histopathological findings with clinical details. Aim: To study the morphological patterns of non-infectious erythematous papulosquamous lesions of skin with clinical diagnosis. Materials and Methods: This was a cross-sectional observational study in all the prediagnosed cases of noninfectious erythematous papulosquamous lesions by the dermatologist in BGS Global Institute of Medical Sciences, Bengaluru from July 2016 to December 2018. Demographic profiles including the clinical and histopathological details were reviewed by consensus opinion by the pathologists. The results were tabulated and analysed using SPSS 22 software version. Results: Out of 90 cases of papulosquamous lesion, lichenoid pattern of reaction 51 (56.66%) was commonest followed by psoriasiform pattern of reaction 39 cases (43.34%). Lichen planus 34 cases (37.8%) was the common diagnosis among the lichenoid pattern of lesion followed by psoriasis 27 cases (30.1%) in psoriasiform pattern of lesions. Histopathological features commonly seen were hyperkeratosis and parakeratosis in both lichen planus and psoriasis. Positive clinicopathological correlation was highest in lichen planus and psoriasis. Conclusion: A broader morphological spectrum of papulosquamous lesions exist. The combined clinical approach with histopathological findings helps in accurate diagnosis of papulosquamous lesions.

Keywords

• clinical correlation
• dermatitis
• histopathological findings
• lichen planus
• morphological patterns
• psoriasis
• spectrum