Bridging the Gap between Clinicoepidemiological and Histopathological Variants of Psoriasis: A Cross-sectional Study

Introduction: Psoriasis is a chronic inflammatory immunemediated skin disease associated with systemic manifestations that affects about 0.5% - 2.5% of the population, which varies according to regions. It is a conglomeration of multiple variants that have distinct morphological features. A histopathological study provides the diagnosis of psoriasis in classic form and its variants. Aim: The present study aimed to analyse the incidence of age, sex, disease duration, and distribution of various psoriasis variants while underscoring the clinical significance of histopathological assessment of epidermal and dermal features. Materials and Methods: The present cross-sectional study was conducted at Baroda Medical College, Vadodara, Gujarat, India, from January 2024 to December 2024. Hundred newly diagnosed patients of different variants of psoriasis visiting the Dermatology Outpatient Department (OPD) were included in the study, and a detailed clinical history with special reference to gender, duration, site of onset, seasonal exacerbation or remission, triggering factors, past treatment, family history and other systemic disease was taken. Complete head-to-toe cutaneous examination and systemic examination were carried out, and findings were noted. Biopsied specimens were processed in the histopathology section and stained with Hematoxylin and Eosin (H&E) stain, and 10 parameters like parakeratosis, elongated rete ridges, Munro’s microabscess, acanthosis, suprapapillary thinning, hypogranulosis, Kogoj abscess, capillary dilatation, dermal infiltrate, and spongiosis were used to assess and classify various types of psoriasis. Collected data were statistically analysed by the Chi-square test and a p-value of <0.05 was considered significant. Results: Total 100 patients were included among which male preponderance with 60 (60%) cases noted, with the maximum cases in the 31-40 year age group. The predominant histological type was Chronic Plaque Psoriasis (CPP) in 44 (44%) cases, followed by Palmoplantar Psoriasis (PPP) in 32 (32%). Amongst various cutaneous features of psoriasis, erythema was present in 79 (79%) followed by plaques 54 (54%). Auspitz sign and Woronoff ring were noted in 40 (40%) and 20 (20%) cases, respectively. Amongst the epidermal histopathological features of psoriasis, parakeratosis was found in 93 (93%) followed by hyperkeratosis 84 (84%). The dermal feature showed dermal infiltrate in 95 (95%) cases. These findings were statistically significant (p-value <0.0001). Conclusion: Present study emphasises the role of histopathological study in various clinical variants of psoriasis to see the two aspects simultaneously for effective diagnosis and treatment. The current study concluded that even though most changes occur in the epidermis, there are a few dermal changes which can help in arriving at a diagnosis.