Clinical, Dermoscopic, and Histopathological Correlation in Non-Infectious Papulosquamous Disorders (Psoriasis, Lichen Planus and Pityriasis Rosea): A Cross-Sectional Study

Objectives: Papulosquamous disorders, including psoriasis, lichen planus, and pityriasis rosea, are common non-infectious inflammatory dermatoses characterised by erythematous, scaly papules and plaques. Despite distinct immunopathological mechanisms, these conditions often present with overlapping clinical features, complicating diagnosis. While histopathology remains the diagnostic gold standard, it is invasive. Dermoscopy has emerged as a non-invasive diagnostic tool that can provide additional morphological insights, enhancing clinical accuracy and reducing unnecessary biopsies. Establishing a comprehensive correlation among clinical, dermoscopic, and histopathological findings may improve diagnostic precision and patient outcomes. The study aims to evaluate and correlate the clinical, dermoscopic, and histopathological features of psoriasis, lichen planus, and pityriasis rosea, and to assess the diagnostic concordance among these modalities in patients with non-infectious papulosquamous disorders. Material and Methods: An analytical cross-sectional study was conducted over one year at the Dermatology Outpatient Department at a tertiary care centre in North India. A total of 162 patients with clinically diagnosed papulosquamous disorders were enrolled. Inclusion required informed consent and biopsy consent. Patients who had received topical therapy within the previous month or systemic therapy within the previous six months, as well as those with infectious, neoplastic, or other papulosquamous dermatoses (such as eczema or seborrheic dermatitis), were excluded after clinical assessment. Each patient underwent detailed clinical evaluation, dermoscopic examination, and punch biopsy. Dermoscopic features such as background colour, vascular morphology and distribution, scale characteristics, and Wickham striae were recorded. Biopsies were processed with hematoxylin and eosin staining and examined for characteristic histopathological features. Data were analysed using IBM SPSS version 22. Statistical correlation between modalities was assessed using the Chi-square test and Cramer's V. Results: The majority of patients were aged 20–29 years (35.2%), with a male predominance (57.4%). Clinically, psoriasis was the most frequent diagnosis (36.4%), followed by lichen planus (30.2%) and pityriasis rosea (12.3%). Histopathological confirmation showed psoriasis in 46.3%, lichen planus in 37%, and pityriasis rosea in 16.7%. Common histological features included parakeratosis (60.5%), acanthosis (51.2%), and dilated capillaries (40.1%). Dermoscopically, dotted vessels (66.7%), white scales (53.1%), and light red background (48.8%) were predominant, with Wickham striae observed in 29% patients. Dermoscopic-histopathological correlation was significant: psoriasis (80%), lichen planus (76.7%), and pityriasis rosea (77.8%) (Cramer's V = 0.708, p <0.001). Clinical-histopathological agreement was also strong: lichen planus (81.7%), pityriasis rosea (74.1%), and psoriasis (72%) (Cramer's V = 0.607, p <0.001). Conclusion: This study demonstrates strong diagnostic concordance among clinical, dermoscopic, and histopathological features in non-infectious papulosquamous disorders. Dermoscopy proves to be a reliable and efficient adjunct to clinical evaluation, providing high diagnostic correlation with histopathology. An integrated approach significantly enhances diagnostic accuracy and supports early, targeted management, particularly in resource-limited settings where biopsy may not always be feasible.