Clinico Histopathological Study of Palmoplantar Psoriasis and Palmoplantar Eczema

Abstract

Background: Palmoplantar psoriasis (PPP) and palmoplantar eczema (PPE) are common inflammatory dermatoses affecting the palms and soles. Due to overlapping clinical and histopathological features, differentiating between these two conditions is often challenging, yet essential, as management strategies and prognosis differ significantly.

Objectives: To evaluate and compare the clinical features of palmoplantar psoriasis and palmoplantar eczema and to correlate these findings with their histopathological characteristics.

Materials and Methods: This cross-sectional study was conducted over a period of 18 months in the Department of Dermatology, Integral Institute of Medical Sciences and Research, Lucknow. A total of 88 clinically suspected cases of palmoplantar psoriasis and palmoplantar eczema were included. Detailed clinical evaluation was performed, followed by histopathological examination of representative skin biopsies. Data were analyzed using the Chi-square test and Fisher’s exact test, with p < 0.05 considered statistically significant.

Results: Of the 88 subjects, 60.2% were clinically diagnosed as palmoplantar eczema and 39.8% as palmoplantar psoriasis. The mean age was 36.6 ± 11.5 years, with a female predominance (72.7%). Itching was the most common presenting complaint (65.9%). Clinicopathological discordance was observed in a subset of cases, with 10.2% of clinically diagnosed psoriasis cases proving to be eczema and 6.8% vice versa. Statistically significant differences (p < 0.001) were noted in both clinical symptoms and histopathological features. Palmoplantar psoriasis showed confluent parakeratosis, hypogranulosis, neutrophilic infiltration, suprapapillary thinning, elongated rete ridges, and minimal spongiosis, whereas palmoplantar eczema was characterized by focal parakeratosis, marked spongiosis, fibrin globules, regular acanthosis, and lymphocytic infiltrate. Correlation between clinical and histopathological diagnosis was weak (r = 0.098).

Conclusion: Palmoplantar psoriasis and palmoplantar eczema show considerable clinical overlap, making exclusive clinical diagnosis unreliable. Histopathological examination plays a crucial role in accurate differentiation and should be considered mandatory in ambiguous or treatment-resistant cases to ensure appropriate management and improved patient outcomes.