Histological differentiation between palmoplantar pustulosis and pompholyx

Abstract

Several histological features could serve as useful 'clues' to differentiate between PPP and pompholyx.

A comparison of inflammatory mediator expression between palmoplantar pustulosis and pompholyx

“…Histopathologically, PPP is classically characterized by large intra‐epidermal unilocular pustules that represent massive accumulations of neutrophils, while pompholyx presents with spongiosis and intraepidermal vesiculation in the acute phase . According to one recent report meticulously describing both diseases, the loss of the granulation layer often portends PPP, while irregular epidermal hyperplasia and spongiotic vesicle are observed more frequently in pompholyx . Dense immunostaining of epithelial membrane antigen in keratinocytes immediately peripheral to vesicles also more strongly favours a diagnosis of pompholyx rather than PPP …”

NOS2 and CCL27: clinical implications for psoriasis and eczema diagnosis and management

“…Exemplarily, difficulties occur when distinguishing seborrheic scalp dermatitis from scalp psoriasis due to psoriasiform hyperplasia and neutrophil infiltration in seborrheic dermatitis or when clarifying the diagnosis of palmoplantar psoriasis and hand eczema. In the latter case, due to the anatomic properties of the palm, histology often provides merely diagnostic clues [2,3].…”

Diagnostic histopathological features distinguishing palmoplantar pustulosis from pompholyx

“…Many reports have described the clinical, histological, immunological and genetic features of PPP patients, but the pathophysiology and etiology remain unclear . Histopathologically, the earliest PPP lesion is a spongiotic vesicle in the lower malpighian layer containing mononuclear cells and some neutrophils.…”

“…Yoon et al . reported that several histological features such as “loss of granular layer”, “irregular epidermal hyperplasia” and “spongiotic vesicle” could aid in the differential diagnosis of PPP and pompholyx.…”

“…Thus, it is sometimes difficult to distinguish between the two diseases because the early vesicles/pustulovesicles of PPP and the vesicles/pustules of pompholyx share many similarities. Recently, Yoon et al . compared the histological features of PPP and pompholyx using a checklist of the histological parameters of psoriasis .…”