ABSTRACT
Psoriasis is a chronic, immune mediated, relapsing, papulosquamous disease having a high prevalence. Since it affects other organ systems such as musculoskeletal system, gastrointestinal system and the eye, it can lead to considerable disability. Although only rarely life threatening, it has high morbidity due to its chronicity and absence of cure. MethodsThis study was conducted over a period of 2 years in the Department of Pathology, Medical College, Thiruvananthapuram. A total of 217 skin biopsy specimens in which a clinical diagnosis / differential diagnosis of psoriasis was made, was studied during this period. Results108 cases out of 217 which were histopathologically diagnosed as psoriasis were studied in detail. Male predominance was noted in the study population. The mean duration of disease in this study was 6.69 yrs. Fifty percentage of the patients had associated comorbidities with hypertension outnumbering others. Among male patients, 26 (32.5 %) had the habit of smoking. The most common presentation was as erythematous scaly plaques, with pruritus being the second most common presentation. Histopathology proved to be conclusive of psoriasis in all cases. Hyperkeratosis was seen in all cases which was the most consistent histopathological feature. Confluent parakeratosis which is one of the characteristic features of psoriasis was seen in 62 (57.4 %) cases with the rest being focal. Other epidermal features studied were papillomatosis, hypogranulosis, suprapapillary thinning, and basal mitotic figures. Spongiosis was seen in 83 (76.9 %), exocytosis of neutrophils in 66 (61.1 %) and Munro’s micro abscess in 42 (38 %) cases. Dilated blood vessel was the most common dermal change observed, seen in 105 (97 %). Lymphocytes were the most frequent upper dermal inflammatory infiltrate observed. Oedema was seen in 5 (4.6 %) of cases. ConclusionsPsoriasiform lesions pose diagnostic dilemma to the treating clinician. To provide a clear-cut diagnosis, histopathological evaluation is essential. It is also important to differentiate between the different variants of psoriasis in the context of treatment. It has an important role in the follow up of psoriatic patients.