Differences in the classical/non-classical histopathological findings of psoriasis patients according to psoriasis subtype, disease duration and severity, anatomical region, and clinical presentation

Authors : Yıldız Gürsel Ürün, Gülden Karakalem, Nuray Can, Meltem Ayyıldız Mercan

Pages : 98-111

Doi:10.53446/actamednicomedia.1384616

View : 97 | Download : 134

Publication Date : 2024-02-29

Article Type : Research Paper

Abstract :Objective: Although histopathological examination is considered the gold standard in the diagnosis of psoriasis, it has limited usefulness in patients with non-classical histopathological and/or clinical presentations. The aim of this study was to examine the distribution of classical and non-classical histopathological findings according to psoriasis subtype, disease duration, disease severity, biopsy site, and classical/non-classical presentation. Methods: We retrospectively reviewed the records of 160 patients with histopathologically confirmed psoriasis. Classical and non-classical histopathological features were determined according to dermatopathology textbooks and literature. Patients were categorized according to disease duration (≤12 and >12 months) and disease severity (Psoriasis Area Severity Index [PASI] ≤10 and >10) at presentation, and classical/non-classical presentation (based on morphology, distribution, nail pitting, and family history). Results: The most common classical histopathological findings were regular acanthosis (99.4%), confluent parakeratosis (96.3%), blood vessels, dilated (93.1%), hyperkeratosis (89.4%), and suprapapapillary plate thinning (89.4%). The most common non-classical histopathological findings were superficial perivascular dermal infiltration (81.3%) and spongiosis (53.8%). Hyperkeratosis (p=0.044) and intraepidermal lymphocyte accumulation (p=0.042) were more frequent in patients with a disease duration >12 months. The presence of Munro microabscess (p=0.010) and stratum basale necrotic keratinocytes (p=0.031) were observed more frequently in patients with PASI >10. Significant hyperkeratosis (p=0.024) and suprapapillary plate thinning (p=0.027) were more common in trunk biopsies compared to other locations. Spongiosis (p=0.005) and intraepidermal lymphocytes (p=0.008) were more common in patients with non-classical clinical presentation. Conclusion: Non-classical histopathological findings can be observed in patients with psoriasis. Clinical features should be considered when evaluating classical/non-classical histopathological findings during diagnosis.
Keywords : dermatopatoloji, histopatoloji, psoriazis, tanı