PSORIASIFORM DERMATITIS.pptx

Dermatology

1. Presenter: Dr. Golla Akshay 1 st 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 S tudy 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 In the study done by Park et al. evaluated the histological differences between psoriasis and seborrheic dermatitis on the scalp. 8

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 To assess the histopathological features of psoriasiform dermatitis. To assess the characteristic microscopical differences between the various forms of psoriasiform dermatitis. 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 a nd 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 Study type: Observational study. Study period: 2 years from May 2023 to April 2025. Place of study : Department of Pathology, Gadag Institute of Medical Sciences , Gadag. Sample size: 73 Patients. Study design: Hospital based cross-sectional study.

17. Materials and Methods The calculation was done by using the formula: n = 4 pq L 2 n = 4x3x97 = 72.75 = 73 4 2   Where; p is prevalence = 3. 3 q = 1- p L is absolute error = ±4

18. Inclusion and Exclusion Criteria Inclusion Criteria: All patients with psoriasiform lesions and who undergo subsequent skin biopsy will be included in the study. Exclusion Criteria: Patients who are on topical or systemic steroids therapy for the last 30 days. Inadequate biopsy specimens (punch biopsy specimens with inadequate sampling of epidermis or dermis, specimens with poorly preserved morphology) 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 Deparaffinize the sections with xylene for 5 minutes. Treat with absolute alcohol: 2 changes of 5 minutes each. Wash with water. Stain in Harris Haematoxylin for 5 minutes. Treat with 1% acid alcohol by 1 quick dip. Wash in running tap water for blueing - 5 to 10 minutes. Stain in 1% aqueous eosin for 2 minutes. Water wash. Dehydrate with alcohol 2 changes. Treat with xylene 2 changes. 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. This process will be repeated till we reach 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 Bhargava S, Mathur R. Psoriasiform dermatoses: the diagnostic challenges revisited. J. Krishna. Inst. Med. Sci. Univ. 2022;11(2):92-104. 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. 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. 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 P athol Res P ract . 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.

27. THANK YOU