International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - Vol 06 Issue 14, July, 2014

Pages: 54-57

Date of Publication: 22-Jul-2014


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CLINICO - MORPHOLOGICAL STUDY OF SKIN DISEASES

Author: R. Thamilselvi, K. Sivakami, Pammysinha, P.M. Subramaniam

Category: Healthcare

Abstract:Background: Skin diseases constitute a major public health problem. The pattern of skin diseases vary from one country to another country. Disease pattern also vary from tissue reactions to vesiculobullous lesions and malignant lesions. Aim: To analyze the clinico-morphological spectrum of skin lesions. Methods: A retrospective study was undertaken to determine the clinico-morphological spectrum of skin lesions from all the skin biopsies, received from Jan 2009 to Aug 2011 (2 and ½ years) in the Department of Pathology, Vinayaka Mission's KirubanandaVariyar Medical College, Salem. Results: A total of 178 cases were reviewed and analysed. The highest number of patients were in the age group of 51-60 years.The incidence of dermatological diseases was more in male patients than female patients. Cystic lesions (26%) were the commonest lesions followed by infectious diseases of skin (13.4%), malignant tumors of skin (13%), alteration in the dermal collagen (8%). Most common site for various skin lesions was extremities followed by scalp region. Clinically the lesionswerevarying from papule, macule, vesicles, nodules to ulcers. The two major tissue reaction patterns, the psoriasiform and the lichenoid reactions were commonly seen in this study. Conclusion: In our study, cystic lesions, infectious diseases and malignant tumors of skin were the most common disorders. The contribution of histopathology to the final diagnosis and there by treatment were significant.

Keywords: Dermatological diseases, Cystic lesions, Malignant tumors, Psoriasiform & Lichenoid reactions.

Full Text:

INTRODUCTION
Skin diseases constitute a major public health problem. The pattern of skin diseases vary from one country to another country. Disease pattern also varies from tissue reactions to vesiculobullous lesions and malignant diseases. The interpretation of skin biopsies requires the identification and integration of two different morphological features- the tissue reaction pattern, the lichenoid reactions and the psoriasiform reaction and other lesions with clinicomorphologicalpattern.

MATERIALS AND METHODS
A retrospective study was undertaken to determine the clinico-morphological spectrum of skin lesions from all the skin biopsies received from Jan2009 to Aug 2011 in the Department of Pathology, Vinayaka Mission’s KirubanandaVariyar Medical College, Salem. Specimens were received as punch biopsy or excision biopsy, in 10% formalin as fixative for histopathological examination. 2-3 μm sized sections were taken and stained with routine Hematoxylin and Eosin stain and special stains were used when necessary. All the cases were reviewed and analysed.

RESULTS
The age distribution pattern revealed that the maximum biopsies (20.2 %) were in the age range of 51-60 years. (Table-1) The incidence of dermatological diseases were more in males 115 cases (64.6%) than females. (Table-2) The anatomic distribution pattern showed that the upper & lower extremities were involved in the maximum number of cases (36.5%) followed by the scalp (13.4%) and neck (11.2%). Clinically the lesions varied from papule, macule, vesicles, nodules to ulcers & combination of all these. Cysts were the commonest skin lesions, among the cystic lesions, keratinous cyst (9.5%) (Fig-1&2) was the most common. In infectious diseases, Leprosy (10 cases 5.6%) was the commonest disease followed by Tuberculosis (6 cases 3.3%) and fungal infections (5 cases 3%). In neoplastic lesions, Basal cell Carcinoma (8 cases 4.4%) (Fig-3&4) was the commonest.In dermal collagenous diseases, calcinosis cutis (Fig 5&6) was the commonest (5 cases 3%) (Table-3) An analysis of the major tissue reaction patterns revealed that the most frequently encountered lesion was the lichenoid group (10 cases, 5.6%) (Fig 7&8) followed by psoriasiform lesion (7 cases 3.9%), (Fig-9&10) Bullous lesions 5%. (Fig11&12) Amongst the lichenoid group of lesions, lichen planus was the most frequentwhereas inpsoriasiform lesions, psoriasis vulgaris was the most common. DISCUSSION In the present study, maximum number of biopsies were seen in the 51-60 years of age, and the minimum number in the age range of 0-10 years. The sex distribution pattern of cases revealed that most of the patients were males ( 64.6%). Limbs were involved in the maximum number of cases (36.5%), followed by the Neck, face, eye (21.9%) and scalp (13.4%). Among the cystic lesions, keratinous cyst was the commonest as seen in literature. We found leprosy was the commonest disease as infectious lesion &majority of cases were presented as hypopigmented macules(1). Basal cell carcinoma (BCC) was themost common neoplasm and most frequently seen on the face (2) as in literature. In our study we had 5 cases of Idiopathic calcinosis cutis, which is cutaneous calcification of unknown cause with normal serum calcium.(3) Lichen planus was most frequently seen in the 20- 40 years of age, but the literature revealed the incidence is seenin 5 th - 6 th decades.(4 ) Lichen planus showed male preponderance in our series and is also described in the literature.Most of our cases of lichen planus occurred on the limbs as seen in the literature. (4,5)

The next most frequently seen lesion was psoriasis in the 40- 70 years of age range. Fry (6) mentioned that two-thirds occurred before the age of 30 years. Griffiths (7) and Bell et. al. (8). mentioned that classic psoriasis is seen in the older age. We found a male preponderance in psoriasis, however Bell et. al. (8) found a female preponderance and Fry found no sex predilection. Pemphigus vulgaris was the commonest lesion and seen in the 4th decade, as seen in literature Salmanpour et. al. (9) series and Aboobaker et. al. series.

CONCLUSION
In our study, cystic lesions were the commonest followed by infectious diseasesand malignant tumors of skin. Correlation of clinical diagnosis with the histopathological diagnosis was positive in 97.1% cases and negative in 2.8% cases. The contribution of histopathology to the final diagnosis and there by treatment were significant.

 

References:

1. Kar, P K. 1994. A clinic Pathological study of macular lesions in leprosy, Indian Journal of Leprosy, 66(4):435-442.

2. Erba P, Farhadi J, Wettstein R, Arnold A, Harr T, Pierer G. Morphoeic basal cell carcinoma of the face. Scand J PlastReconstrSurg Hand Surg. 2007;41(4):184-8

3. Cook BE Jr, Bartley GB. Epidemiologic characteristics and clinical course of patients with malignant eyelid tumors in an incidence cohort in Olmsted County, Minnesota. Ophthalmology. 1999; 106(4):746–50. 3.

4. James WD, Berger TG, Elston DM. Andrews' Diseases of the Skin: Clinical Dermatology. 11th ed. Philadelphia (PA): Elsevier/Saunders; 2011. p. 516-8

5. Boyd AS, Neldner KH. Lichen planus. J Am AcadDermatol 1991;25:593-613.

6. Fry L. Psoriasis. Br J Dermatol 1988;119:445- 61.

7. Griffiths CE, Christophers E, Barker JN, Chalmers RJ, Chimenti S, Krueger GG, et. al. A classification of psoriasis vulgaris according to phenotype. Br J Dermatol 2007;156:258- 62.

8. Bell LM, Sedlack R, Beard CM, Perry HO, Michet CJ, Kurland LT. Incidence of psoriasis in Rochester, Minn, 1980-1983. Br J Dermatol 1991;127:1184-7.

9. Salmanpour R. Shalkar H, Namaki MR, Rahman-Shenar MR. Epidemiology of Pemphigus in south Western Iran- a

10 years Retrospective study(1991-2000) International Journal of Dermatology 2006, 45(2):23-5


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One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to editor@ijcrr.com for more details.

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Best Article Award

A Study by M. Muthu Uma Maheswari et al. entitled "A Study on C-reactive Protein and Liver Function Tests in Laboratory RT-PCR Positive Covid-19 Patients in a Tertiary Care Centre – A Retrospective Study" is awarded Best Article of Vol 13 issue 06 Special issue Modern approaches for diagnosis of COVID-19 and current status of awareness
A Study by Gainneos PD et al. entitled "A Comparative Evaluation of the Levels of Salivary IgA in HIV Affected Children and the Children of the General Population within the Age Group of 9 – 12 Years – A Cross-Sectional Study" is awarded Best Article of Vol 13 issue 05 Special issue on Recent Advances in Dentistry for better Oral Health
A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" is awarded Best Article of Vol 13 issue 06
A Study by Chen YY and Ghazali SRB entitled "Lifetime Trauma, posttraumatic stress disorder Symptoms and Early Adolescence Risk Factors for Poor Physical Health Outcome Among Malaysian Adolescents" is awarded Best Article of Vol 13 issue 04 Special issue on Current Updates in Plant Biology to Medicine to Healthcare Awareness in Malaysia
A Study by Kumari PM et al. entitled "Study to Evaluate the Adverse Drug Reactions in a Tertiary Care Teaching Hospital in Tamilnadu - A Cross-Sectional Study" is awarded Best Article for Vol 13 issue 05
A Study by Anu et al. entitled "Effectiveness of Cytological Scoring Systems for Evaluation of Breast Lesion Cytology with its Histopathological Correlation" is awarded Best Article of Vol 13 issue 04
A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03
A Study by Tarek Elwakil et al. entitled "Led Light Photobiomodulation Effect on Wound Healing Combined with Phenytoin in Mice Model" is awarded Best Article of Vol 13 issue 02
A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24
A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
A Study by Habiba Suhail et al. entitled "Effect of Majoon Murmakki in Dysmenorrhoea (Usre Tams): A Standard Controlled Clinical Study" is awarded Best Article for Vol 12 issue 22
A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by Leow Jun Xian and Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh et al. entitled "Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma COLAKOGLU entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by Arpita M. et al entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09
Late to bed everyday? You may die early, get depression
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88 Percent Of Delhi Population Has Vitamin D Deficiency: ASSOCHAM Report

List of Awardees

A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


Awardees of COVID-19 Research

Woman Researcher Award

A Study by Neha Garg et al. entitled "Optimization of the Response to nCOVID-19 Pandemic in Pregnant Women – An Urgent Appeal in Indian Scenario" published in Vol 12 issue 09

A Study by Sana Parveen and Shraddha Jain entitled "Pathophysiologic Enigma of COVID-19 Pandemic with Clinical Correlates" published in Vol 12 issue 13

A Study by Rashmi Jain et al. entitled "Current Consensus Review Article on Drugs and Biologics against nCOVID-19 – A Systematic Review" published in Vol 12 issue 09

Emerging Researcher Award

A Study by Madhan Jeyaraman et al. entitled "Vitamin-D: An Immune Shield Against nCOVID-19" published in Vol 12 issue 09

Study by Dheeraj Kumar Chopra et al. entitled "Lipid-Based Solid Dispersions of Azilsartan Medoxomil with Improved Oral Bioavailability: In Vitro and In Vivo Evaluation" published in Vol 12 issue 19


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