Psoriasis or not? Review of 51 clinically confirmed cases reveals an expanded histopathologic spectrum of psoriasis

Thinh Chau, Kory K. Parsi, Toru Ogawa, Maija Ht Kiuru, Thomas Konia, Chin-Shang Li, Maxwell A Fung

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: Psoriasis is usually diagnosed clinically, so only non-classic or refractory cases tend to be biopsied. Diagnostic uncertainty persists when dermatopathologists encounter features regarded as non-classic for psoriasis. Objective: Define and document classic and non-classic histologic features in skin biopsies from patients with clinically confirmed psoriasis. Methods: Minimal clinical diagnostic criteria were informally validated and applied to a consecutive series of biopsies histologically consistent with psoriasis. Clinical confirmation required 2 of the following criteria: (1) classic morphology, (2) classic distribution, (3) nail pitting, and (4) family history, with #1 and/or #2 as 1 criterion in every case Results: Fifty-one biopsies from 46 patients were examined. Classic features of psoriasis included hypogranulosis (96%), club-shaped rete ridges (96%), dermal papilla capillary ectasia (90%), Munro microabscess (78%), suprapapillary plate thinning (63%), spongiform pustules (53%), and regular acanthosis (14%). Non-classic features included irregular acanthosis (84%), junctional vacuolar alteration (76%), spongiosis (76%), dermal neutrophils (69%), necrotic keratinocytes (67%), hypergranulosis (65%), neutrophilic spongiosis (61%), dermal eosinophils (49%), compact orthokeratosis (37%), papillary dermal fibrosis (35%), lichenoid infiltrate (25%), plasma cells (16%), and eosinophilic spongiosis (8%). Conclusions: Psoriasis exhibits a broader histopathologic spectrum. The presence of some non-classic features does not necessarily exclude the possibility of psoriasis.

Original languageEnglish (US)
JournalJournal of Cutaneous Pathology
DOIs
StateAccepted/In press - 2017

Fingerprint

Psoriasis
Skin
Biopsy
Pathologic Dilatations
Nails
Plasma Cells
Keratinocytes
Eosinophils
Uncertainty
Neutrophils
Fibrosis

Keywords

  • Dermatopathology
  • Histopathology
  • Inflammatory skin disease
  • Psoriasiform dermatitis
  • Psoriasis

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Histology
  • Dermatology

Cite this

@article{b9f7de1de9104d1486b7043dd5388274,
title = "Psoriasis or not? Review of 51 clinically confirmed cases reveals an expanded histopathologic spectrum of psoriasis",
abstract = "Background: Psoriasis is usually diagnosed clinically, so only non-classic or refractory cases tend to be biopsied. Diagnostic uncertainty persists when dermatopathologists encounter features regarded as non-classic for psoriasis. Objective: Define and document classic and non-classic histologic features in skin biopsies from patients with clinically confirmed psoriasis. Methods: Minimal clinical diagnostic criteria were informally validated and applied to a consecutive series of biopsies histologically consistent with psoriasis. Clinical confirmation required 2 of the following criteria: (1) classic morphology, (2) classic distribution, (3) nail pitting, and (4) family history, with #1 and/or #2 as 1 criterion in every case Results: Fifty-one biopsies from 46 patients were examined. Classic features of psoriasis included hypogranulosis (96{\%}), club-shaped rete ridges (96{\%}), dermal papilla capillary ectasia (90{\%}), Munro microabscess (78{\%}), suprapapillary plate thinning (63{\%}), spongiform pustules (53{\%}), and regular acanthosis (14{\%}). Non-classic features included irregular acanthosis (84{\%}), junctional vacuolar alteration (76{\%}), spongiosis (76{\%}), dermal neutrophils (69{\%}), necrotic keratinocytes (67{\%}), hypergranulosis (65{\%}), neutrophilic spongiosis (61{\%}), dermal eosinophils (49{\%}), compact orthokeratosis (37{\%}), papillary dermal fibrosis (35{\%}), lichenoid infiltrate (25{\%}), plasma cells (16{\%}), and eosinophilic spongiosis (8{\%}). Conclusions: Psoriasis exhibits a broader histopathologic spectrum. The presence of some non-classic features does not necessarily exclude the possibility of psoriasis.",
keywords = "Dermatopathology, Histopathology, Inflammatory skin disease, Psoriasiform dermatitis, Psoriasis",
author = "Thinh Chau and Parsi, {Kory K.} and Toru Ogawa and Kiuru, {Maija Ht} and Thomas Konia and Chin-Shang Li and Fung, {Maxwell A}",
year = "2017",
doi = "10.1111/cup.13033",
language = "English (US)",
journal = "Journal of Cutaneous Pathology",
issn = "0303-6987",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Psoriasis or not? Review of 51 clinically confirmed cases reveals an expanded histopathologic spectrum of psoriasis

AU - Chau, Thinh

AU - Parsi, Kory K.

AU - Ogawa, Toru

AU - Kiuru, Maija Ht

AU - Konia, Thomas

AU - Li, Chin-Shang

AU - Fung, Maxwell A

PY - 2017

Y1 - 2017

N2 - Background: Psoriasis is usually diagnosed clinically, so only non-classic or refractory cases tend to be biopsied. Diagnostic uncertainty persists when dermatopathologists encounter features regarded as non-classic for psoriasis. Objective: Define and document classic and non-classic histologic features in skin biopsies from patients with clinically confirmed psoriasis. Methods: Minimal clinical diagnostic criteria were informally validated and applied to a consecutive series of biopsies histologically consistent with psoriasis. Clinical confirmation required 2 of the following criteria: (1) classic morphology, (2) classic distribution, (3) nail pitting, and (4) family history, with #1 and/or #2 as 1 criterion in every case Results: Fifty-one biopsies from 46 patients were examined. Classic features of psoriasis included hypogranulosis (96%), club-shaped rete ridges (96%), dermal papilla capillary ectasia (90%), Munro microabscess (78%), suprapapillary plate thinning (63%), spongiform pustules (53%), and regular acanthosis (14%). Non-classic features included irregular acanthosis (84%), junctional vacuolar alteration (76%), spongiosis (76%), dermal neutrophils (69%), necrotic keratinocytes (67%), hypergranulosis (65%), neutrophilic spongiosis (61%), dermal eosinophils (49%), compact orthokeratosis (37%), papillary dermal fibrosis (35%), lichenoid infiltrate (25%), plasma cells (16%), and eosinophilic spongiosis (8%). Conclusions: Psoriasis exhibits a broader histopathologic spectrum. The presence of some non-classic features does not necessarily exclude the possibility of psoriasis.

AB - Background: Psoriasis is usually diagnosed clinically, so only non-classic or refractory cases tend to be biopsied. Diagnostic uncertainty persists when dermatopathologists encounter features regarded as non-classic for psoriasis. Objective: Define and document classic and non-classic histologic features in skin biopsies from patients with clinically confirmed psoriasis. Methods: Minimal clinical diagnostic criteria were informally validated and applied to a consecutive series of biopsies histologically consistent with psoriasis. Clinical confirmation required 2 of the following criteria: (1) classic morphology, (2) classic distribution, (3) nail pitting, and (4) family history, with #1 and/or #2 as 1 criterion in every case Results: Fifty-one biopsies from 46 patients were examined. Classic features of psoriasis included hypogranulosis (96%), club-shaped rete ridges (96%), dermal papilla capillary ectasia (90%), Munro microabscess (78%), suprapapillary plate thinning (63%), spongiform pustules (53%), and regular acanthosis (14%). Non-classic features included irregular acanthosis (84%), junctional vacuolar alteration (76%), spongiosis (76%), dermal neutrophils (69%), necrotic keratinocytes (67%), hypergranulosis (65%), neutrophilic spongiosis (61%), dermal eosinophils (49%), compact orthokeratosis (37%), papillary dermal fibrosis (35%), lichenoid infiltrate (25%), plasma cells (16%), and eosinophilic spongiosis (8%). Conclusions: Psoriasis exhibits a broader histopathologic spectrum. The presence of some non-classic features does not necessarily exclude the possibility of psoriasis.

KW - Dermatopathology

KW - Histopathology

KW - Inflammatory skin disease

KW - Psoriasiform dermatitis

KW - Psoriasis

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U2 - 10.1111/cup.13033

DO - 10.1111/cup.13033

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