Role of skin biopsy in papulosquamous lesions—a comparative study

Abstract

Dermatologists make their clinical diagnosis mostly through skin reaction patterns. This study was done to assess the correlation between the clinical diagnoses of papulosquamous lesions made at dermatological clinics and the diagnosis of these lesions at biopsy. Our study lends insight into the list of most common to least common lesions of papulosquamous lesions. This is a cross-sectional study conducted at a dermatological clinic, on those patients who consulted to a dermatologist. This presumptive investigation on papulosquamous lesion was implied on 83 patients as lichen planus, lichen nitidus, lichen striata, lichenoides dermatitis, psoriasis, pityriasis rubra pilaris, pityriasis rosea, pityriasis lichenoides, pityriasis lichenoides et varioliformis acuta (PLEVA) and Reiter’s disease and then the biopsy was performed on these patients for the confirmation of the clinical diagnosis to assess that diagnosis given by biopsy in these patients matched to the clinical diagnosis and whether it showed any deviation from the clinical diagnosis made by dermatologist. The histopathology report confirmed the clinical diagnosis in 67.5 % and gave the diagnosis in 32.5 % of the total number of cases, which means that 32.5 % cases were those in which the diagnosis provided by the biopsy did not match the diagnosis provided by the clinical diagnosis. The total number of cases was 83: lichen planus occurred most frequently, i.e. 32.5 %, biopsy confirmed diagnosis in 21 patients and gave correct diagnosis in six patients, followed by psoriasis 24.1 %. In the case of psoriasis, seven patients were misdiagnosed at clinics, and in these patients, biopsy gave the correct diagnosis of psoriasis. The frequency of pityriasis rubra pilaris and lichenoides dermatitis was the same, 14.5 %. About six patients with pityriasis rubra pilaris and six cases with lichenoides dermatitis were given wrong diagnosis at clinics, and the correct diagnosis was provided at biopsy; PLEVA was diagnosed in 6 % of the cases and pityriasis rosea in 3.6 %. Reiter’s disease occurred in about 2.4 % of the cases and lichen nitidus and lichen striata in 1.2 % of the cases. Biopsy gave the correct diagnosis of one patient with pityriasis rubra pilaris, one with Reiter’s disease and one with PLEVA. This research investigation, postulated and enquired on the basis of histopathology reports, confirmed the clinical hypothesis in 67.5 % of cases and gave the diagnosis in 32.5 % of the total number of cases. These results verified the aforementioned hypothesis that the patients who are diagnosed with the papulosquamous lesion must undergo biopsy for the confirmation of the disease.