Papulosquamous Skin Lesions Research Articles

Histopathology of Papulosquamous Skin Lesions: A Prospective Cohort Study of 305 Cases

ABSTRACT Introduction: Papulosquamous lesions are a heterogeneous group of disorders and they form the largest group of skin diseases. They are characterized clinically by scaly papules and plaques and are usually erythematous. These lesions show considerable overlap in clinical and histopathological features. Materials and Methods: The present prospective cohort study was carried out at an urban teaching medical hospital. Histopathological features of 305 skin biopsies of clinically diagnosed as papulosquamous lesions were studied in detail for 3 years from February 2020 to February 2023. Histological features were correlated with clinical features and a final diagnosis was made. Standard statistical tests were applied to analyze data. Microsoft Excel was used to express tables and data were expressed in percentile and numerical. Results: Statistical analysis was done. The most common clinical lesions were papules (49.50%) followed by plaques (43.27%) and both papules and plaque (34.42%). Maximum cases were of lichen planus (n = 120) followed by psoriasis (n = 98). The least common lesion was lichen nitidus (n = 2). Out of 305 cases, 52.13% were female (n = 159) and 47.86% were male (n = 146). Out of 146 male patients, 35.61% of lesions were psoriasis (n = 52) followed by 33.56% lichen planus (n = 49). Out of 159 female patients, 44.65% were lichen planus (n = 71) as compared to 28.93% psoriasis (n = 46). Conclusion: Papulosquamous lesions show considerable overlap in clinical and histopathological features. Specific histopathological diagnosis is important to distinguish these lesions because in these disorders, prognosis, and treatment vary significantly. There is a need for lucid clinical information and description of these lesions to correlate with histological features which enables definitive histopathology diagnosis.

Individualized Homoeopathic Treatment in An Immune Mediated Skin Condition-Plaque Psoriasis: A Case Report

Psoriasis is an aggressive and widespread chronic, recurring, immune-mediated skin condition. This significantly harms the affected patient’s physical, emotional, and psychosocial wellness. As a result of the restricted therapeutic options for psoriasis in traditional practice, an alternate system of approach is necessary. A 57 years old male presented with papulosquamous skin lesions with excessive white scaling for 10 years. After careful clinical evaluation, the case was diagnosed with Plaque Psoriasis. Going through the individualistic approach of Homoeopathy Arsenicum iodatum was prescribed in 50 millesimal potencies. Clinically, the improvement was consistent and evident as the reduction in Psoriasis Area and Severity Index (PASI) score. The case revealed a commending therapeutic efficacy of Individualised Homoeopathic treatment in Plaque Psoriasis. A 10 years duration autoimmune skin lesion was relieved within a very shorter span of treatment and not recurred after 10 months of the last medication. Thus, through this case, homoeopathic medicine showed a complete recovery of Plaque Psoriasis nullifying the tendency of recurrence. For any other conclusion regarding causal attribution, a large-scale randomised controlled trial is required.

Histopathological study of non-infectious papulosquamous lesions of skin

Background: Papulosquamous diseases are characterized by scaly papules and plaques with similar clinical picture which leads to diagnostic confusion. A definitive histopathological diagnosis is required for effective treatment of such diseases. Aims and Objectives: The aim of the study was to study the clinicohistopathological correlation of different non-infectious papulosquamous skin lesions. Materials and Methods: Skin punch biopsy specimens from 100 clinically diagnosed/suspected non-infectious papulosquamous skin diseases were received in the Department of Pathology at a tertiary care hospital. The specimens obtained were subjected to formalin fixation and paraffin embedding, stained with hematoxylin and eosin and studied. Results: A total of 100 cases were studied. The most common lesion was psoriasis (42) followed by lichen planus (40). Maximum numbers of cases were seen in the age group of 31–60 years (61%). Males (54%) were commonly affected. Positive clinicopathological correlation was observed in 85% cases. Conclusion: Contribution of histopathology is definitely significant in overcoming clinical diagnostic dilemma in certain papulosquamous disorders.

S2153 A Case of Proton Pump Inhibitor Causing Systemic Drug-Induced Lupus

Introduction: Drug induced lupus erythematosus (DILE) is a well documented autoimmune phenomenon that can be triggered by exposure to certain medications. Presented here is a case of systemic drug induced lupus erythematosus from a proton pump inhibitor (PPI), which represents a fairly uncommon reaction to this medication. Case Description/Methods: A 63 year old female with history of gastroesophageal reflux disease (GERD) presented to clinic complaining of typical heartburn pain and globus sensation for which she was prescribed pantoprazole. After 2 weeks of daily use, she developed pain and swelling of bilateral metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints, photosensitive malar rash, patchy alopecia, ‘gnawing’ diffuse abdominal pain (different than GERD symptoms), and oral ulcers. Her pantoprazole was stopped, and 2 weeks later her symptoms resolved. Review of the her medical record revealed that she had prior exposure to 2 other PPI's in the past that both were associated with development of similar symptoms. Use of omeprazole caused pain and swelling of her right MCP joints, and several years later use of esomeprazole caused severe pain and swelling of the left elbow. In both cases, discontinuation of her PPI caused resolution of symptoms. Her labs were notable for positive anti histone antibody and negative ANA, dsDNA, RF, anti CCP. Discussion: DILE has three basic variants; systemic, subacute cutaneous, and chronic cutaneous. The type of drug induced lupus and severity of symptoms is strongly associated with the specific drug of exposure. PPI's are most associated with subacute cutaneous DILE, although this remains an overall rare adverse reaction. Subacute cutaneous DILE presents with formation of annular or papulosquamous skin lesions and mild (if any) systemic symptoms. Our case is more consistent with systemic DILE. Review of literature reveals few case reports of systemic DILE from PPI use. Systemic DILE presents with multi-system involvement with constitutional symptoms, myalgias, arthralgias, and serositis. Symptoms resolve with withdrawal of the agent. The case above clearly demonstrates this illness script through multiple exposures to PPI. Classic SLE is ruled out in this case due to this temporal relationship with drug exposure, as well as her antibody profile positive for anti-histone and negative for other SLE-associated antibodies. This case highlights the importance of considering atypical drug reactions, even when prescribing relatively common medications.

Coronavirus disease 2019 (COVID-19) manifestations during pregnancy in all three trimesters: A case series.

BackgroundCoronavirus disease 2019 (COVID-19) pandemic has raised concerns about the susceptibility amongst different groups of the population. Pregnant women are one such group. This study was conducted to investigate the effect of COVID-19 on pregnancy and maternal/neonatal outcomes.Case presentationThis case series was conducted on 16 pregnant women with COVID-19 from March 21 to May 11, 2020. Clinical characteristics, pregnancy complications, medication used, maternal/neonatal outcomes, and fatality rate were investigated through this study. The mean age of the patients was 30.06 yrs. Patients from all three trimesters were included (1 in first, 5 in second, and 10 in the third trimesters). The most common clinical symptoms were shortness of breath (n = 10), dry cough (n = 10), myalgia (n = 8), and chills (n = 7). Also, three cases had papulosquamous skin lesions with fissuring. The most common laboratory results were leukocytosis (n = 8), increased liver enzymes (n = 6), elevated CRP (n = 5), and thrombocytopenia (n = 4). There was one case of maternal mortality, five of premature labor pain (PLP), two of preeclampsia, and two of placenta accreta. Twelve pregnancies were terminated (nine cesarean sections, three vaginal deliveries). Among neonates, we had 6 cases of preterm labor. All neonates had negative PCR results.ConclusionClinical manifestations and paraclinical results were similar to non-pregnant patients. There was no evidence of vertical transmission. PLP and premature rupture of membranes (PROM) were the most common complications in the second and third trimesters of pregnant COVID-19 women, which can lead to rupture of the uterus. Termination and delivery should be planned individually.

Leprosy presenting with papulosquamous skin lesions in a case of human immunodeficiency virus infection

Leprosy has a wide range of clinical manifestations, which sometimes imposes a clinical challenge and may lead to misdiagnosis. Interactions between leprosy and human immunodeficiency virus (HIV) have been little studied and poorly understood to date. However, coinfection still poses dilemmas in leprosy as to the occurrence of the immune reconstitution inflammatory syndrome manifesting as clinical leprosy and reversal reactions, higher chances of relapse after the successful completion of the multidrug therapy (MDT) and drug interactions between MDT and antiretroviral therapy. Furthermore, coinfection can lead to atypical clinical manifestations of leprosy. Herein, we describe a rare presentation of leprosy in a patient of HIV infection who reported with papulosquamous lesions over both upper and lower limbs histopathologically consistent with Hansen's disease.

Clinicopathological study of papulosquamous skin disorders in a tertiary health-care center

Background: Papulosquamous skin disorder is a group of heterogenous dermatoses with a distinct histomorphological feature. The characteristic primary lesion is a papule, usually erythematous, that has a variable amount of scaling on the surface. The most common papulosquamous dermatoses are psoriasis, lichen planus, and pityriasis rosea. Because all papulosquamous disorders are characterized by scaling papules, clinical confusion may result during their diagnosis. Our study is to evaluate histomorphological findings in various papulosquamous skin disorders encountered at RIMS, Imphal. Materials and Methods: Skin biopsies of clinically diagnosed papulosquamous skin disorders along with their relevant clinical data received during a period of 2 years from September 2017 to August 2019 were included in the study. The diagnosis was confirmed by histopathological examination using hematoxylin and eosin stain. Results: A total of 115 papulosquamous skin disorders were studied with 75 cases of psoriasis (11–80 years), 36 cases of lichen planus (2–70 years), and 4 cases of pityriasis rosea. Age ranges from 2 to 80 years. Maximum cases were seen in the age group of 31–50 (70.6%) with a mean age of 39.18 years. Both genders were almost equally affected with a male: female ratio of 1.13:1. An analysis of the clinical with histopathological diagnosis of these papulosquamous skin lesions revealed a positive correlation in 76 (66.08%) cases and a negative correlation in 39 (2.9%) cases. Conclusion: Because of the varied clinical presentation and histopathological patterns of papulosquamous skin disorder, it is important to characterize the types of papulosquamous lesions as far as possible for definitive treatment.

A Clinico-Histopathological Correlative Study of Non-Infectious and Erythematous Papulosquamous Lesions of Skin in a Tertiary Care Hospital

Context: Papulosquamous lesions of skin are the most frequently seen conditions encountered by both dermatologists and pathologists. These conditions have a similar clinical picture; hence a definite histopathological diagnosis can solve the overlapping clinical features of various papulosquamous lesions of skin. Aims: To study the histopathological features of various subcategories of papulosquamous skin lesions and to assess the correlation between clinical diagnosis provided and the histopathological diagnosis obtained. Settings and Design: The study is done in a Tertiary care hospital which includes 150 skin biopsies received from Department of Dermatology. Methods and Material: The skin biopsy specimens were subjected to formalin fixation and paraffin embedding followed by staining with hematoxylin and eosin. The histopathological features of various papulosquamous lesions were analysed and clinicopathological correlation was done for the 150 cases of skin biopsies which were clinically suspected/ diagnosed as papulosquamous skin lesions. Statistical analysis used: Universal sampling done and this is a clinico-histopathological correlative study done for a period of 18 months. Results: Out of the 150 skin biopsies of papulosquamous lesions, psoriasis turned out to be the most common lesion. The papulosquamous skin lesions were commonly seen in males. 28% cases were of psoriasis vulgaris and 25% cases were of Lichen planus occupying the top two commonest papulosquamous skin lesions and a positive correlation with histopathological diagnosis turned out to be 76%. Conclusions: The complexity in diagnosing papulosquamous lesions due to features of clinical overlap can be overcome by the histopathological examination and findings which helps to diagnose the various subcategories of papulosquamous skin lesions.

Histopathological Evaluation of Non-infectious Erythematous Papulo-squamous Skin Lesions in North-West India

Histopathological Evaluation of Non-infectious Erythematous Papulo-squamous Skin Lesions in North-West India

A Clinico-histopathologic Study of Non-infectious Papulosquamous Lesions of Skin at Tertiary Care Hospital

A Clinico-histopathologic Study of Non-infectious Papulosquamous Lesions of Skin at Tertiary Care Hospital

Study of noninfectious papulosquamous lesions- An experience at a teritiary hospital

Study of noninfectious papulosquamous lesions- An experience at a teritiary hospital - IJPO- Print ISSN No: - 2394-6784 Online ISSN No:- 2394-6792 Article DOI No:- 10.18231/j.ijpo.2020.009, Indian Journal of Pathology and Oncology-Indian J Pathol Oncol

A study of dermatological manifestations in patients attending the rheumatology outpatient department at a tertiary care hospital

Background: Autoimmune processes commonly involve skin along with the musculoskeletal system, resulting in inflammatory diseases characterized by concurrent mucocutaneous and rheumatic manifestations. Aim: We undertook a clinical study to assess the pattern, type, extent, severity, and morphology of dermatological manifestations in rheumatology patients, to analyze the correlation of dermatoses observed with the type of rheumatological disorder, and to look for the side effects of drug therapy including disease-modifying antirheumatic drugs. Materials and Methods: A cross-sectional descriptive study carried out in the outpatient department (OPD) setting of 100 patients, having joint and/or bone involvement associated with cutaneous disorders, attending rheumatology OPD of a tertiary care hospital were included and followed up for 6 months to assess the mucocutaneous manifestations. Patients with no cutaneous manifestations were excluded from the study. Statistical analysis was done using STATA 13 IC. Results: Papulosquamous skin lesions (45%) were the most common dermatological manifestations in the study, followed by nail changes (30%), photosensitivity (20%), Raynaud's phenomenon (17%), and malar rash (15%). Drug-induced cutaneous features were seen in 18% of patients. Cutaneous manifestations were seen most commonly in the connective tissue diseases group (55%), followed by seronegative arthritis (34%), rheumatoid arthritis (8%), and erythema nodosum (3%). Frequently affected age group was 31–40 years (41%), followed by 41–50 years (23%) of age group. The most common therapeutic interventions causing cutaneous side effects were systemic steroids. Conclusions: Many patients attending the rheumatology OPD present with varied mucocutaneous manifestations, and they can also develop numerous drug-related cutaneous side effects once started on antirheumatic medications. Hence, a collaborative clinic between a rheumatologist and a dermatologist is a necessity which will help in holistic patient management and disease remission.

Clinicopathological correlation of noninfectious erythematous papulosquamous cutaneous lesions in a tertiary care hospital

Aims and Objectives: Papulosquamous lesions, the largest conglomerate of skin diseases, are characterized by scaling papules and plaques which amount to lots of confusion, and hence, a definitive histopathological diagnosis has a significant role. Our study was thus aimed at evaluation of correlation between clinical diagnosis with histopathological diagnosis of different noninfectious erythematous papulosquamous skin lesions encountered in a tertiary care center. Materials and Methods: A total of 50 cases of noninfectious erythematous, papulosquamous lesions prediagnosed by dermatologists of the same institute were included over a period of 1 year. Diagnosis was confirmed by histopathological examination using hematoxylin and eosin stain. Cases were tabulated according to the distribution of age, gender, localization of lesions, clinical, and histopathological diagnosis. Results: Majority of the patients were in the 20–40 years age group (66%) with slight female preponderance (52%). The limbs (42%) were most frequently involved site. Histopathologically, lichen planus was the most common (52%) followed by psoriatic lesions (20%), pityriasis rosea (4%), pityriasis rubra pilaris (4%), subacute cutaneous lupus erythmatosus (4%), prurigo simplex (4%), pityriasis lichenoides chronica (4%), urticaria (2%) and ashy dermatosis (2%). Correlation of clinical with histopathological diagnosis was positive in 92% cases and negative in 8% cases. Conclusion: The contribution of histopathology to the final diagnosis was significant. Skin biopsy is thus valuable in daily dermatology practice and appropriate clinicopathological correlation is very important for the effective diagnosis and treatment of patients.

A Histopathologic Study of Papulosquamous Lesions of Skin

A Histopathologic Study of Papulosquamous Lesions of Skin

A Study on Evaluation of Mast Cells in Papulo-Squamous Lesions of Skin

A Study on Evaluation of Mast Cells in Papulo-Squamous Lesions of Skin

Clinicopathological Study of Non-Infectious Erythaematous Papulosquamous Skin Diseases.

Papulosquamous diseases are characterized by scaly papules and plaques with similar clinical picture which amounts to confusion and hence, a definitive histopathological diagnosis goes a long way in treatment of such diseases. The aim of the study was to study the histomorphology of non-infectious, erythaematous, papulosquamous lesions of skin with clinicopathological correlation. Skin biopsies from 150 clinically diagnosed/suspected non-infectious erythaematous, papulosquamous skin diseases were received in the Department of Pathology. The specimens obtained were subjected to formalin fixation and paraffin embedding, stained with haematoxylin and eosin and studied. The lesions were classified as psoriasis, lichen planus, lichen nitidus, lichen striatus, pityriasis rosea and pityriasis rubra pilaris and clinicopathological correlation was done. Papulosquamous lesions were common in the elderly. Males were commonly affected except in pityriasis rosea. Among the 150 cases studied, 72 cases (48%) were histopathologically confirmed to be papulosquamous lesions. Psoriasis was the most common lesion. Key histopathological features and clinicopathological correlation gives a conclusive diagnosis. The importance of specific histomorphological diagnosis lies in distinguishing these lesions as the treatment and prognosis varies widely.

Ticlopidine-induced subacute cutaneous lupus erythematosus: A case report and literature review

Many drugs have been reported to induce lupus in a minority of patients. Ticlopidine hydrochloride inhibits platelet aggregation and is widely used for the prevention of thrombosis. There have been only a few reports of ticlopidine-induced lupus. Here, we review 13 previously reported cases and describe the case of a 71-year-old man with ticlopidine-induced subacute cutaneous lupus erythematosus. His diagnosis was supported by the appearance of papulosquamous skin lesions on sun-exposed areas and detectable anti-Ro/SS-A antibodies, shortly after drug initiation as well as the gradual resolution of these symptoms after the discontinuation of ticlopidine. Our case highlights that when a patient presents with subacute cutaneous lupus erythematosus-like skin lesions, ticlopidine should be considered as a potential causative agent.

Histopathological spectrum of non-infectious erythematous, papulo-squamous lesions

Background : Papulosquamous diseases assume considerable importance because of their frequency of occurrence. Separation of each of these becomes important because the treatment and prognosis for each tends to be disease specific. Aim of study is histopathology of non inf ectious erythematous, papulo-squamous lesions of skin and age and sex distribution with incidence . Materials and methods : In present study 200 cases of all age and sex who have come with non-infectious erythematous papulosquamous skin disorders were examined and included 80 cases skin biopsies were taken. Study was done for a period of one year from June 2012 to May 2013. Results : Out of 80 cases, 62 were males and 18 females. 69 (86.50 %) cases showed compatible clinical as well as histopa thological diagnoses .In skin biopsies evaluation psoriasis is higher 34(42.5%) followed by lichen planus 24(30%). Conclusion : Age group of 31-40 years was more affected with p apulo-squamous lesions. Sex distribution pattern revealed a male preponderance. Psoriasis constitute s major skin lesions cases followed by lichenplanus . Clinical and histopathological diagnosis correlated in majorit y of cases Histopathological diagnosis is important as it effects the clinical management.

Drug-Induced Subacute Cutaneous Lupus Erythematosus Associated with Nab-Paclitaxel Therapy

Drug-induced lupus erythematosus (dile) syndromes are documented complications of chemotherapeutic agents, including paclitaxel. Subacute cutaneous lupus erythematosus (scle) is a distinct dile syndrome presenting with characteristic annular or papulosquamous skin lesions in a photosensitive distribution with associated high anti-ssa titres. Previously, dile syndromes complicating paclitaxel therapy have been attributed to polyethoxylated castor oil (Kolliphor EL: BASF, Ludwigshafen, Germany), the biologic solvent included in the drug's original formulation (Taxol: Bristol-Myers Squibb, Montreal, QC), rather than the parent chemotherapy molecule. Here, we report a characteristic case of drug-induced scle complicating treatment with nanoparticle albumin bound (nab)-paclitaxel (Abraxane: Celgene, Summit, NJ, U.S.A.), a solvent-free taxane formulation. The pertinent English-language literature is also discussed. This case report is the first to link solvent-free paclitaxel with scle, and it suggests that the parent molecule is responsible for the reaction.

A Case of Malignant Histiocytosis Showing Papulosquamous Skin Lesions and Fever as Initial Manifestations

A Case of Malignant Histiocytosis Showing Papulosquamous Skin Lesions and Fever as Initial Manifestations