Histopathological Study of Psoriasis and Its Grading According to Trozak Scoring System

  • Neelu Vashist Government Medical College, Kota, Rajasthan
  • Ila Sharma Government Medical College, Kota, Rajasthan
  • Mukul Sharma Government Medical College, Kota, Rajasthan
Keywords: psoriasis, histology, skin disease, trozak grading

Abstract

Background: Psoriasis is a chronic papulosquamous disorder of undefined etiology, occuring in 0.09 to 11.4% population. Different clinical types occur with varying histopathology. Early and Late onset psoriasis have been defined based on age at presentation. Methods: Cases diagnosed as Psoriasis, both clinically and histologically, were examined for the individual features of Psoriasis. Histomorphological grading of the lesions was also done using the Trozak scoring system. Result: The mean age of the patients was 42.26 with a male predominance (M:F=3.5: 1). Early onset cases constituted 71% of the total cases, while late onset cases were 29%. The histopathological features were found to be variably present. Acanthosis was observed in 96% cases. Hyperkeratosis (94%), parakeratosis (66%), club shaped rete ridges (88%) with regular elongation of rete ridges (72%) with, suprapapillary plate thinning (74%), hypogranulosis (72%), elongation and edema of dermal papillae (88%) were other features seen in majority of cases. Perivascular mononuclear infiltrate in upper dermis of papillae (76%), dermal (76%) and epidermal (78%) neutrophils, spongiform pustules of Kogoj (24%), Munro’s microabscess (28%), were the inflammatory changes observed, present to a greater extent in the early onset cases than the late onset cases. The Trozak scoring system gave an average score of 9.44, with no significant difference in the early and late onset cases of Psoriasis. Conclusion: Entirely typical histological features are found only in a small percentage of biopsy specimens, even if only clinically typical lesions of psoriasis are examined.

Author Biographies

Neelu Vashist, Government Medical College, Kota, Rajasthan
Department of Pathology
Ila Sharma, Government Medical College, Kota, Rajasthan
Department of Pathology
Mukul Sharma, Government Medical College, Kota, Rajasthan
Department of Dermatology and Veneral diseases

References

1. Fry L. Psoriasis. Br J Dermatol 1988;119:445-61
2. World Health Organization. Global report on psoriasis. 2016. WHO Library Cataloguing-in-Publication Data. 2016.
3. Gibbs SA. Skin disease and socioeconomic conditions in rural Africa: Tanzania. International journal of dermatology. 1996 Sep;35(9):633-9.
4. Danielsen K, Olsen AO, Wilsgaard T, Furberg AS. Is the prevalence of psoriasis increasing? A 30‐year follow‐up of a population‐based cohort. British Journal of Dermatology. 2013 Jun;168(6):1303-10.
5. Institute for Health Metrics and Evaluation (IHME). Global Burden of Disease Study 2010: Results by Cause 1990–2010. Seattle: IHME; 2012.
6. Boehncke W-H, Schön MP. Psoriasis. Lancet. 2015;386(9997):983–94.
7. Theodorakopoulou E. An investigation of late onset psoriasis (Doctoral dissertation, The University of Manchester (United Kingdom)). 2014.
8. Dubertret L, Mrowietz U, Ranki A, Van De Kerkhof PC, Chimenti S, Lotti T, Schäfer G, EUROPSO patient survey. European patient perspectives on the impact of psoriasis: the EUROPSO patient membership survey. British Journal of Dermatology. 2006 Oct;155(4):729-36.
9. Pandit GA, Narayankar SL. Significance of clinicopathological correlation in psoriasis. Medical Journal of Dr. DY Patil University. 2015 Jul 1;8(4):481.
10. Baker H, Ryan TJ. Generalized pustular psoriasis. British Journal of Dermatology. 1968 Dec 1;80(12):771-93
11. Ferrándiz C, Pujol RM, García-Patos V, Bordas X, Smandía JA. Psoriasis of early and late onset: a clinical and epidemiologic study from Spain. Journal of the American Academy of Dermatology. 2002 Jun 1;46(6):867-73.
12. Tuzun B. The Differential Diagnosis of Psoriasis Vulgaris. Pigmentary Disorders. 2016;3(245):2376-0427.
13. Krengel S, Schaumburg-Lever GM, Geilen CC, Orfanos CE. Histopathology and electron microscopy of psoriasis. BASIC AND CLINICAL DERMATOLOGY. 1998;16:409-20.
14. Mendonca SM, Devaraju S. Suprabasal mitotic index: A cell kinetic aid in psoriasis diagnosis. Indian Journal of Dermatopathology and Diagnostic Dermatology. 2017 Jan 1;4(1):2.
15. De Rosa G, Mignogna C. The histopathology of psoriasis. Reumatismo. 2007;59(1s):46-8.
16. Raghuveer C, Shivanand DR, Rajashekar N. A Clinico-histopathological Study of Psoriasis. International Journal of Scientific Study. 2015 Oct 1;3(7):176-9.
17. Trozak DJ. Histologic grading system for psoriasis vulgaris. International journal of dermatology. 1994 May;33(5):380-1.
18. Icen M, Crowson CS, McEvoy MT, Dann FJ, Gabriel SE, Kremers HM. Trends in incidence of adult-onset psoriasis over three decades: a population-based study. Journal of the American Academy of Dermatology. 2009 Mar 1;60(3):394-401.
19. Moorchung N, Khullar JS, Mani NS, Chatterjee M, Vasudevan B, Tripathi T. A study of various histopathological features and their relevance in pathogenesis of psoriasis. Indian journal of dermatology. 2013 Jul;58(4):294.
20. Henseler T, Christophers E. Psoriasis of early and late onset: characterization of two types of psoriasis vulgaris. Journal of the American Academy of Dermatology. 1985 Sep 1;13(3):450-6.
21. Ejaz A, Raza N, Iftikhar N, Iftikhar A, Farooq M. Presentation of early onset psoriasis in comparison with late onset psoriasis: A clinical study from Pakistan. Indian Journal of Dermatology, Venereology, and Leprology. 2009 Jan 1;75(1):36.
22. Bedi TR. Clinical profile of psoriasis in North India. Indian Journal of Dermatology, Venereology, and Leprology. 1995 Jul 1;61(4):202.
23. Kaur I, Kumar B, Sharma KV, Kaur S. Epidemiology of Psoriasis in a Clinic From North India. Indian journal of dermatology, venereology and leprology. 1986;52(4):208-12.
24. Puri N, Mahajan BB. A study of clinical and biochemical correlation in patients of psoriasis in acute exacerbation. Journal of Pakistan Association of Dermatology. 2016 Dec 2;24(3):236-40.
25. Aydin O, Engin B, Oğuz O, İlvan Ş, Demirkesen C. Non‐pustular palmoplantar psoriasis: is histologic differentiation from eczematous dermatitis possible?. Journal of cutaneous pathology. 2008 Feb;35(2):169-73.
26. Park JH, Park YJ, Kim SK, Kwon JE, Kang HY, Lee ES, Choi JH, Kim YC. Histopathological differential diagnosis of psoriasis and seborrheic dermatitis of the scalp. Annals of dermatology. 2016 Aug 1;28(4):427-32.
27. Kim BY, Choi JW, Kim BR, Youn SW. Histopathological findings are associated with the clinical types of psoriasis but not with the corresponding lesional psoriasis severity index. Annals of dermatology. 2015 Feb 1;27(1):26-31.
28. Lundin Å, Fredens K, Michaelsson G, Venge P. The eosinophil granulocyte in psoriasis. British Journal of Dermatology. 1990 Feb 1;122(2):181-93.
29. Bai S, Sowmya S. Histopathologic diagnostic parameters of psoriasis; a clinicopathological study. Int J Res Med Sci 2016;4:1915-20.
Published
2019-11-26
Section
Original Article