An Observational Study of Clinicopathological Correlation of Pediatric Dermatoses – Discordance as a Vehicle toward Broadening Clinical Knowledge

Background: Skin diseases are a major health problem in the pediatric age group, constituting 20% to 30% of outpatient visits to pediatricians and dermatologists. Skin diseases in children differ when compared to adults. Hence, skin biopsy plays an eminent role for counseling and prognostication. Objective: To study the clinical and histopathological correlation in pediatric patients who require skin biopsy. Materials and Methods: A retrospective study was undertaken after ethics approval in the department of pediatric dermatology of a tertiary care referral hospital for children where 286 skin biopsies were analyzed over 10 years. Descriptive statistics was analyzed. Clinical provisional diagnosis and pathological skin reactions were evaluated for concordance. Results: Definitive and descriptive concordance was noted in 73.77% of cases. Nonconclusive histological diagnoses not amounting to a final diagnosis were seen in 15.03% with most reporting perivascular miscellaneous inflammatory infiltrate. Around 11.18% reported a definitive histopathological diagnosis in complete contrast to the clinical differentials provided by us. Although the first clinical differential diagnosis for which biopsy was performed was led by papulosquamous disorders, concordance rates for any of the three clinical differentials provided were highest for genodermatoses at 13.63%. Clonal proliferative disorders and malignancies constituted 27 cases out of which 4 were diagnosed even though it was not suspected further highlighting the paramount importance of skin biopsy to dermatologists. Conclusions: Histopathological concordance was noted in 73.7% of clinical diagnosis with an additional 11.18% of cases showing off-guard diagnosis. Our study highlights the importance of histopathology, especially during neonatal period and for genodermatoses where it can play a crucial role. Additional focus on discrepancy in clinical and pathological diagnosis is also provided.