A Cross-Sectional Study to Assess the Role of Dermoscopy in Differentiating Palmar Psoriasis, Chronic Hand Eczema, and Eczema in Psoriatico.

BACKGROUND: Overlapping clinical features often make the differentiation between palmar psoriasis, hand eczema, and eczema in psoriatico a difficult task. In such cases, history and biopsy often aid in the diagnosis. Dermoscopy acts as a link between clinical dermatology and dermatopathology. AIM: To study the dermoscopic features in biopsy-proven cases of palmar psoriasis, hand eczema, and eczema in psoriatico. METHODS: A 1-year cross-sectional study was conducted using a video dermatoscope, Dinolite premier AM4113ZT, on 60 patients having clinical diagnosis of either of palmar psoriasis, hand eczema, and eczema in psoriatico. Statistical analysis was performed using R i386 3.6.3 software. RESULTS: Among 60 patients, 38 were psoriatics followed by 14 of eczema and 8 of eczema in psoriatico. On dermoscopy, characteristic features of psoriasis lesions were diffuse scaling in 76.3% (29/38), white scales in 60.5% (23/38), and dotted vessels in 76.3% (29/38) along with regular distribution of vessels in 71% (27/38); in hand eczema lesions, diffuse scaling in 78.5% (11/14), white and yellow scales in 57.1% (8/14), and dotted vessels in 78.5% (11/14) along with a patchy distribution of vessels in 57.1% (8/14); in eczema in psoriatico, diffuse scaling in 75% (6/8), white and yellow scales in 62.5% (5/8), and dotted vessels in 87.5% (7/8) along with regular distribution of vessels in 50% (4/8). CONCLUSION: The various patterns and combinations reflecting specific features give an insight into the cases of palmar psoriasis, hand eczema, and eczema in psoriatico on dermoscopy. However, a study with larger sample size is required to validate the findings of our study. LIMITATIONS: Inability to perform a patch test for eczema due to unavailability.

Differential histopathological and immunohistochemical findings between palmar psoriasis and chronic hand eczema.

BACKGROUND: The differential diagnosis between palmar psoriasis (PP), chronic hand dermatitis (CHE), and hyperkeratotic hand dermatitis (HHD) is challenging. OBJECTIVES: We sought to distinguish the histopathological and immunohistochemical characteristics between PP, CHD, and HHD. MATERIALS & METHODS: Hands, clinically diagnosed with PP, CHD, or HHD, were further evaluated using skin biopsy sections based on haematoxylin and eosin staining and immunohistochemical analysis for ß-defensin 2 and interleukin-36γ. RESULTS: Confluent parakeratosis, absent granular layer, and psoriasiform epidermal hyperplasia were more common in PP and HHD relative to CHE. The level of ß-defensin 2 expression in the stratum corneum and interleukin-36γ in the stratum granulosum was higher in PP and HHD relative to CHD. CONCLUSION: Considering the similarities of histopathological and immunohistochemical findings, HHD may be an inflammatory disorder with a pathogenesis similar to that of PP, rather than CHD.

Hyperkeratotic hand eczema: Eczema or not?

BACKGROUND: Hyperkeratotic hand eczema (HHE) is a typical clinical hand eczema subtype with a largely unknown pathophysiology. OBJECTIVE: To investigate histopathology, expression of keratins (K), epidermal barrier proteins, and adhesion molecules in HHE. METHODS: Palmar skin biopsies (lesional and perilesional) were obtained from seven HHE patients and two healthy controls. Moreover, 135 candidate genes associated with palmoplantar keratoderma were screened for mutations. RESULTS: Immunofluorescence staining showed a significant reduction of K9 and K14 in lesional skin. Upregulation was found for K5, K6, K16, and K17 in lesional skin compared with perilesional and healthy palmar skin. Further, upregulation of involucrin and alternating loricrin staining, both in an extracellular staining pattern, was found. Filaggrin expression was similar in lesional, perilesional, and control skin. No monogenetic mutations were found. CONCLUSION: Currently, the phenotype of HHE is included in the hand eczema classification system; however, it can be argued whether this is justified. The evident expression of filaggrin and involucrin in lesional skin does not support a pathogenesis of atopic eczema. The upregulation of K6, K16, and K17 and reduction of K9 and K14 might contribute to the underlying pathogenesis. Unfortunately, comparison with hand eczema studies is not possible yet, because similar protein expression studies are lacking.

Iontophoretic delivery of methotrexate in the treatment of palmar psoriasis: A randomised controlled study.

BACKGROUND/OBJECTIVES: Palmoplantar psoriasis is a localised variant of psoriasis. Topical therapy is the preferred treatment modality, but in severe and recalcitrant cases, systemic drugs like methotrexate are prescribed, with potential for significant adverse effects. Iontophoresis is gaining popularity in enhancing the transdermal delivery of drugs in ionic state. This study was undertaken to evaluate and compare the efficacy of topical methotrexate by iontophoresis technique with clobetasol propionate 0.05% ointment in the treatment of palmar psoriasis. METHODS: This was a prospective randomised controlled study conducted on patients with palmar psoriasis. Group 1 patients (n = 31) were treated with once weekly iontophoretic delivery of methotrexate over 6 sittings, and group 2 patients (n = 31) were treated with clobetasol propionate 0.05% ointment, twice daily for 6 weeks. Severity of palmar psoriasis was assessed by modified Palmoplantar Pustular Psoriasis Area and Severity Index (m-PPPASI), and treatment was considered as satisfactory when there was >50% improvement. RESULTS: Sixty two patients were recruited, of which 50 completed the study. Eight out of 25 (32%) patients in group 1 and 12 out of 25 (48%) patients in group 2 showed satisfactory improvement at the end of 6 weeks. However, this difference was statistically not significant (P = 0.25). Burn injury was noted in 12 (48%) group 1 patients with no adverse effects in group 2. CONCLUSION: Iontophoretic delivery of methotrexate is a promising therapeutic modality, the efficacy of which is comparable to that of clobetasol propionate ointment in the treatment of palmar psoriasis.

Dermoscopy in differentiating palmar syphiloderm from palmar papular psoriasis.

Palmar syphiloderm is one of the most common presentations of secondary syphilis and its recognition is of utmost importance in order to promptly identify such a disease and initiate appropriate workup/management. However, the differential diagnosis with palmar papular psoriasis often poses some difficulties, with consequent possible diagnostic errors/delays and prescription of improper therapies. In this report, we underline the role of dermoscopy as a supportive tool to facilitate the non-invasive recognition of palmar syphiloderm and its distinction from palmar papular psoriasis.

Dermoscopy in differential diagnosis of palmar psoriasis and chronic hand eczema.

Clinical differentiation between palmar psoriasis and chronic hand eczema may sometimes be a diagnostic challenge; in such cases histopathological analysis helps to differentiate the two conditions. In the present study, palmar psoriasis and chronic hand eczema were investigated using dermoscopy and the significance of specific dermoscopic features was assessed in order to improve their non-invasive differentiation. Ten patients with biopsy-proven palmar psoriasis and 11 patients with biopsy-proven chronic hand eczema were included in the study. We found that the presence of diffuse white scales was significant in palmar psoriasis whereas the presence of yellowish scales, brownish-orange dots/globules and yellowish-orange crusts was significant in chronic hand eczema.