Non‐pustular palmoplantar psoriasis: is histologic differentiation from eczematous dermatitis possible?

Abstract

The differential diagnosis of psoriasis affecting palmoplantar skin might be troublesome because of the anatomic properties of this region. Both palmoplantar psoriasis and eczematous dermatitis of this skin area share similar histologic features. The punch biopsies from 17 patients with psoriasis and 25 with eczematous dermatitis were evaluated, blind to the clinical diagnosis. Vertically situated multiple foci of parakeratosis, alternating with orthokeratosis, were the only statistically significant feature in the differential diagnosis of palmoplantar psoriasis [76.5% (13/17), p ¼ 0.005]. In contrast, multiple foci of parakeratosis [70.6% (12/17)], loss of granular layer at least in focal areas [41.2% (7/17)], presence of neutrophils at the summits of parakeratosis [4% (1/17)], presence of neutrophils and/or plasma in the parakeratotoic foci [94.1% (16/17) and 11.8% (2/17)], psoriasiform epidermal hyperplasia [88.2% (15/17)], spongiosis restricted to the lower parts of the epidermis [47.1% (8/17)], dyskeratotic cells [82.4% (14/17)], thinning of suprapapillary plate [58.8% (10/17)], edema of the papillary dermis [29.4% (5/17)], presence of tortous and dilated capillaries in the papillary dermis [52.9% (9/17) and 76.5% (13/17)] and extravasated erythrocytes [29.4% (5/17)] were found to be more common in palmoplantar psoriasis compared with eczematous dermatitis; but none of them was statistically significant. Interestingly, spongiotic vesicles were seen in most of the patients with psoriasis [76.5% (13/17)]. In conclusion, according to our findings, many features of palmoplantar psoriasis overlapped with those of eczematous dermatitis. However, detection of multiple parakeratotic foci, placed vertically, alternating with orthohyperkeratosis, could be considered in favor of palmoplantar psoriasis. Aydin O, Engin B, Oguz O, _Ilvan S x, Demirkesen C. Non-pustular palmoplantar psoriasis: is histologic differentiation from eczematous dermatitis possible?

Histological differentiation between palmoplantar pustulosis and pompholyx

“…The histological parameters were established according to the features that were considered helpful in the diagnosis of psoriasis in literature 4 . These parameters had been also used to differentiate non‐pustular palmoplantar psoriasis from eczematous dermatitis 5 …”

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].…”

Bcl-2: Is it an easier way to differentiate psoriasis and eczema?

“…It is shown that the most important histopathological distinction between these two diseases is multi focal parakeratosis (5) . In the other study, while it is emphasized even the histopathological differentiation of psoriasis and eczema is very difficult, it has been suggested that these two diseases have similar clinical, histologic, biologic and therapeutic responses and there is an overlap condition (6) .…”