Clinicopathological Study of Hyperkeratotic Lesions of Palms and Soles: An Observational Study

Introduction: Hyperkeratotic, fi ssure-prone, infi ltrated lesions over the palms and soles is a very common skin condition. These conditions, do not always present with typical manifestations, such as classical skin lesions and nail changes and therefore known clinical features about these diseases might not be helpful in diagnosis. Thus this study was conducted to study the clinical and histopathological features of hyperkeratotic lesions of palms and soles and to correlate them clinically. Materials and Methods: The study was conducted in outpatient Department of Dermatology, Venereology & Leprology, Mahatma Gandhi Medical College & Hospital, Jaipur. 100 consecutive cases of hyperkeratotic lesions of palms and soles presenting from November 2010 to October 2013, were included in the study. The cases included were, psoriasis of palms and soles, Hyperkeratotic eczema and Tinea pedis and tinea manuum (Hyperkeratotic variety). Results: The data was analysed under following categories; age incidence, incidence in relation to sex, incidence of duration of the disease, incidence of seasonal variation of the disease, incidence of presence or absence of itching, symmetry of the disease, incidence of involvement of nails. Histopathological analysis was done on basis of; degree of hyperkeratosis, degree of parakeratosis, degree of acanthosis, degree of spongiosis, presence of Munro’s microabscesses, presence of Pustule of Kogoj, presence of supra-papillary thinning in stratum malpighium, degree of elongation of rete ridges, degree of elongation of papillae and clubbing of papillae, degree of exocytosis, type of infi ltrate in the dermis, type of infi ltrate around blood vessels. Special investigations conducted were positivity of skin lesion for fungus by KOH examination, Positivity of nail for fungus by KOH examination, results of pus for culture and sensitivity, PAS positive fungal cases. Conclusion: Thus from the present study of 100 cases of hyperkeratotic lesions of palms and soles it can be concluded that: classical clinical and histopathological features are seen in most of the cases. Cases in which they are absent, skin biopsy and special investigations has to be done to aid in diagnosis. There is a considerable overlap in clinical and histopathological feature of these conditions and the sensitivity and specifi city of special tests is low. Thus a clinicopathological correlation is required for appropriate diagnosis. This would help in a better management of patients.