|Year : 1997 | Volume
| Issue : 2 | Page : 82-84
Histopathological study of hyperkeratosis of palms and soles
A Chopra, Maninder, SS Gill
Clinically it is sometimes difficult to differentiate the various hyperkeratosis of palms and soles like psoriasis of palms and soles, pustulosis palmaris et plantaris, hyperkeratotic tinea and hyperkeratotic eczema. To differentiate amongst these conditions we have to take the help of histopathology. Here we are presenting the data of 292 cases of hyperkeratosis of palms & soles examined histologically by doing Haematoxylin and Eosin staining for the typical changes of the above mentioned conditions and PAS for the demonstration of the fungus in stratum corneum in cases of hyperkeratotic tinea.
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Chopra A, Maninder, Gill S S. Histopathological study of hyperkeratosis of palms and soles.Indian J Dermatol Venereol Leprol 1997;63:82-84
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Chopra A, Maninder, Gill S S. Histopathological study of hyperkeratosis of palms and soles. Indian J Dermatol Venereol Leprol [serial online] 1997 [cited 2020 Jul 9 ];63:82-84
Available from: http://www.ijdvl.com/text.asp?1997/63/2/82/4523
Hyperkeratosis is a histological term and refers to increased thickness of stratum corneum. Acquired case of hyperkeratosis of palms and soles which sometimes cause difficulty in clinical diagnosis and need the help of histopathology are psoriasis of palms and soles, pustulosis palmaris et plantaris (PPP), hyperkeratotic tinea and hyperkeratotic eczema. Psoriasis of plams and soles show histologically marked hyperkeratosis with focal mounds of parakeratosis and Munro's microabscesses within the parakeratotic area of horny layer. There is thinning of supra-papillary portion of stratum malpighii, regular elongation of rete ridges with thickening of their lower portion and elongation with clubbing of papillae. In pustulosis palmaris et plantaris, the typical histological picture is presence of fully developed large, unilocular, rounded, intraepidermal pustule with many neutrophils located in the cavity with spongiform change in the wall of the pustule, alongwith the other features of psoriasis.Histologically hyperkeratotic tinea shows picture of chronic dermatitis and the fungus can be demonstrated in the stratum corneum using PAS as deeply red spores and hyphae.Hyperkeratotic eczema shows marked hyperkeratosis, some parakeratosis and spongiosis with scattered mononuclear cells with increased collagen in the dermis, manifesting as fibrosis.
Materials and Methods
The material for the present study was obtained from the Outpatient Department of Dermatology and Venereology, Rajindra Hospital and Medical College, Patiala (Pb.). 292 cases of hyperkeratosis of palms and soles were subjected to histopathological examination. Complete clinical history, general physical examination and relevant investigations were done. Biopsy material was obtained from the hyperkeatotic area. Skin was properly cleaned with spirit and infiltrated with 2% xylocaine. After complete anaesthesia was achieved, biopsy Was taken with the help of a scalpel. The depth of the biopsy was kept so as to include both epidermis and dermis. The sample thus obtained was put in 10% formalin and sent for histopathological examination. The histopathology was studied after staining the sections with H & E stain and PAS stain.
Out of 64 cases of psoriasis of palms and soles, mild hyperkeratosis was present in 22 (34.37%) cases, and moderate in 42 (65.62%). Diffuse parakeratosis was present in 40 (62.5%) and patchy in 24 (33.5%). Suprapaillary thinning of stratum malpighii was present in 21 (32.8%). Mild elongation of rete ridges was present in 12 (18.75%), moderate in 38 (59.37%) and marked in 14 (21.87%) cases. Elongation of papillae was present in all the cases while in 41 (64.06%), alongwith elongation, clubbing was also present. Mild acanthosis was present in 8 (12.5%), moderate in 39 (60.09%) and marked in 17 (26.56%) cases. Neutrophilic spongiosis was present in 48(75%) cases. Munro's microabscesses were present in 61 (95.31%) and pustules of Kogoj were present in 48.(75%) cases. In the dermis neutrophilic infiltrate was present in 5 (7.81%), mononuclear in 29(45.81%) and mixed in 27(42.18%). Mild thickness of blood vessel wall was noted in 21(32.81%) cases. Increase in the thickness of collagen was noted in 12 (18.75%) cases.
Out of 84 cases of pustulosis palmaris et plantaris, mild hyperkeratosis was present in 38 (45.23%) cases and in the rest minimal hyperkeratosis was present. In 27 (32.14%) diffuse parakaratosis was present and in 57 (67.85%) focal parakeratosis was present. Suprapapillary thinning was present in only 3 (3.57%), cases. Elongation of rete ridges was mild in 24 (28.27%), moderate in 54 (64.28%) and marked in 5 (5.95%) cases. Elongation of papillae was present in 70 (83.33%) cases and elongation with clubbing was present in 8 (9.52%) cases. Acanthosis was mild in 14 (16.60%), moderate in 58 (69.04%) and marked in 11 (13.09%). Spongiosis was present in 50 (59.52%) cases.
Neutrophilic exocytosis was present in 56 (66.60%) and absent in the rest. Munro's microabscesses were seen in 83 (98.80%) and spongiform pustule of Kogoj in 70 (83.33%) cases. Unilocular pustule was present in 37 (44.04%) cases. In the dermis, neutrophilic infiltrate was present in 12 (14.28%) and mononuclear in 44 (52.38%) cases. There was insignificant thickening of blood vessel wall with minimal increase in the thichness of collagen.
Among 36 cases of hyperkeratotic tinea pedis and manuum mild hyperkeratosis was present in 23 (63.88%) and moderate in 13 (36.11%). Parakeratosis was present in 19 (52.77%) cases only. Suprapapillary thinning of stratum malpighii, Munro's microabscesses or spongifrom pustule were absent. Mild elongation of rete ridges was present in 12 (33.33%), moderate in 3 (8.33%) and marked in 19 (52.71%) cases. Acanthosis was mild in 6 (16.6%), moderate in 7 (19.4%) and marked in 22 (61.1%) cases. Spongiosis was present in 15 (41.66%) with exocytosis of mononuclear cells in 8 (22.2%) cases only. Dermal infiltrate was of mononuclear cells in 29 (80.55%) and no infiltrate in 7 cases. Mild thickness of blood vessel wall was noted in 11 (30.55%) cases. In 12 (33.33%) mild increase in the thichness of collagen was present. PAS positive fungus in stratum corneum was detected in 20 (55.55%) cases.
In 108 cases of hyperkeratotic eczema, marked hyperkeratosis was present in 36 (33.33%), moderate in 69 (63.88%) and mild in 3 (2.77%) cases. Acanthosis was mild in 18 (16.6%), moderate in 63 (58.3%) and marked in 26 (24.7%) cases. Marked spongiosis was present in 65 (60.18%) with exocytosis of mononuclear cells in 46 (42.5%) cases. Dermal infiltrate of mononuclear cells was detected in 91 (84.25%) cases. Thickness of blood vessel wall was mildly increased in 27 (25%), moderate in 56 (50.92%) and marked in 11 (10.18%) cases. Increase in the thickness of collagen was noted in 81 (75%) cases with mild increase in 18 (16.16%), moderate in 40 (37.03%), marked in 23 (21.29%) cases and normal thickness in 27 (25%) case.
The main histopathological findings for the diagnosis of psoriasis of palms and soles are hyperkeratosis with diffuse parakeratosis, prominent suprapapillary thinning of stratum malpighii, elongation with clubbing of rete ridges, neutrophilic exocytosis, Munro's microbscesses, pustule of Kogoj in stratum malpighii but no unilocular pustule. In the dermis only vessel wall thicking was a prominent feature. Pinkus and Mehregan (1966) noted elongation and clubbing of papillae in most of their cases. Vanscott and Ekel (1963) noted thickening and tortuosity of blood vessels in most of the cases.
In pustulosis palmaris et plantaris the histopathology was similar to psoriasis of plams and soles but in addition unilocular pustule was a prominent finding. Altmeyer, Buhles and Kreig (1992) described the development of unilocular pustule as the most pathognomic histologic picture of PPP.
Hyperkeratotic tinea was diagnosed by hyperkeratosis with minimal parakeratosis. Presence of PAS positive hyphae and spores in stratum corneum helped in the diagnosis. Kligman et al (1951) described the presence of PAS positive spores and hyphae in stratum corneum in cases of tinea manuum and pedis.
In hyperkeratotic eczema marked hyperkeratosis with prominent spongiosis and mononuclear cell exocytosis was present. Dermis showed prominent increase in the thickness of collagen and increase in the thickness of blood vessel wall. Hersle and Mobacken (1982) described spongiosis alongwith mononuclear cell infiltrate in the epidermis in most of their cases. Agrup (1969) described that increase in the thickness of collagen manifests as fibrosis.
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