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ORIGINAL ARTICLE
Year : 2016  |  Volume : 17  |  Issue : 4  |  Page : 258-262

Clinicohistopathological profile of 85 pediatric patients attending skin outpatient department: A retrospective analysis at a municipal hospital of middle-east region of Ahmedabad


Department of Skin and VD, Smt. N.H.L. Municipal Medical College, Ahmedabad, Gujarat, India

Date of Web Publication7-Oct-2016

Correspondence Address:
Ankur Chauhan
34/Sector-6, Chanakyapuri, Ghatlodia-380 061, Ahmedabad
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-7250.179494

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  Abstract 

Introduction: Skin diseases are a major health problem in pediatric age group. Skin biopsy and histopathological examination are required in clinically challenging situation to clinch the correct diagnosis.
Aims and Objectives: To recognize clinical and histopathological relevance in different pediatric dermatoses and to compare the results.
Materials and Methods: A total of 85 skin biopsies were taken over a period of 3 years between August 1, 2012, and July 31, 2015, at our tertiary care hospital and were analyzed by histopathological study.
Results: A total of 85 pediatric patients were included in this study. Of these, female were 48 (56.47%). Main diseases diagnosed during the study were bacterial diseases – 20 (23.52%), noninfectious papulosquamous lesions – 13 (15.29%); nevi, vascular tumors and malformations, and viral diseases were 6 (7.05%) each.
Conclusion: The histopathologic diagnosis inturn is used as an adjuvant to clinical diagnoses to aid in the management of patients.

Keywords: Clinical diagnosis, histopathological diagnosis, pediatric dermatoses, skin biopsy


How to cite this article:
Solanki A, Chauhan A. Clinicohistopathological profile of 85 pediatric patients attending skin outpatient department: A retrospective analysis at a municipal hospital of middle-east region of Ahmedabad. Indian J Paediatr Dermatol 2016;17:258-62

How to cite this URL:
Solanki A, Chauhan A. Clinicohistopathological profile of 85 pediatric patients attending skin outpatient department: A retrospective analysis at a municipal hospital of middle-east region of Ahmedabad. Indian J Paediatr Dermatol [serial online] 2016 [cited 2020 Feb 22];17:258-62. Available from: http://www.ijpd.in/text.asp?2016/17/4/258/179494


  Introduction Top


Skin diseases are a major health problem in pediatric age group and are associated with significant morbidity.[1],[2] Pediatric patients can present with a wide range of skin diseases. In many of these cases, a diagnosis can be made on clinical examination alone. In the real world of clinical medicine, a histologic description and differential diagnosis for a difficult case is often more likely to be useful than a single“specific” diagnosis that may be correct in its own frame of reference but wrong or misleading in the total clinicopathologic context of a particular patient.[3]

Histopathology is the gold standard for most of the dermatologic diagnosis.[4] Skin biopsies are easy to perform and can be carried out under direct visual control. It assists in the process of codifying patients into disease groups. Skin biopsy is also done for therapeutic, prognostic, and academic purpose. Pediatric dermatoses which are frequently submitted for skin biopsy are infectious diseases, papulosquamous disorders, nevi, connective tissue disorders, vascular tumors and malformations, vesiculobullous disorders, etc.[5] The purpose of this study is to find out clinicopathological concordance of various pediatric dermatoses.


  Materials and Methods Top


A retrospective study was undertaken during the period of August 2012–July 2015 at the dermatology outpatient department of a tertiary care hospital. A total of 85 children aged up to 15 years and requiring skin biopsy to confirm the diagnosis were enrolled in the study. A detailed general, cutaneous, and systemic examination followed by biopsy was carried out.

Informed and written consent from the child and the family for the skin biopsy had been taken.

There are various techniques of performing skin biopsy, and any particular one is based on the type and site of the lesion and also proficiency of the dermatologist.[6] 1% lignocaine was given subcutaneously for local anesthesia.[7] Biopsies were taken and preserved in 10% formalin which sent to the pathology department for analysis. All the sections were stained with hematoxylin and eosin stain. Other special stains were done to confirm the diagnosis.[8],[9]

The clinical and histopathological findings were recorded in proforma for analysis and interpretation of data.


  Observations Top


[Table 1] shows the majority of pediatric dermatoses belonged to infections (23.52%) followed by noninfectious papulosquamous group (15.29%). [Table 2] shows maximum histopathological correlation in nevi, disorders of sweat glands, pigmentary disorders, and neutrophilic dermatoses (100%) and minimum histopathological correlation in eczema and dermatitis (66.66%). [Table 3] shows maximum dermatoses in school going children (88.25%) and minimum dermatoses in infants (4.7%). [Table 4] shows gender distribution in which female: male ratio is 1.3:1. [Table 5] shows different groups and disease which are diagnosed in pediatric age group during histopathological study. It includes infections, noninfectious paulosquamous disorders, connective tissue disorders, Vascular tumors and malformations, Nevi, Vesiculobullous disorders, Tumors and cysts of epidermis, Disorders of sweat glands, Pigmentary disorders, Photosensitive disorders, Eczema and dermatitis, Neutrophilic dermatoses and other.
Table 1: Number of cases and percentage in each group of disease

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Table 2: Clinicohistopathological correlation in each group of disease

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Table 3: Distribution of various dermatoses in different pediatric age group

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Table 4: Sexwise distribution of cases

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Table 5 : Different group of diseases and disease diagnosed in the study

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Infections includes bacterial, viral as well as fungal infections. Nevi group includes epidermal and melnocytic nevi. In other group which are not categorized in any of the above groups are included in other group.

[Table 6] shows gender distribution in five main group having equal sex involvement in bacterial as well as viral infections while noninfectious papulosquamous disorder, vascular tumor and malformations, and nevi groups have female predominance.
Table 6: Age and sex wise distribution of cases in the five main group of disease

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  Discussion Top


In the present study, out of 20 cases of bacterial disease, 14 cases (70%) were of leprosy and 4 cases (20%) were of cutaneous tuberculosis. In our study, the cases of leprosy show male: female ratio of 1:1. In a study by Choudhury in Bangladesh and Jindal et al. in Himachal Pradesh, male: female ratio was 3:1.[10],[11] In a study by Lal et al. in Pondicherry, there was no sex predilection in leprosy patients.[12]

As regarding the type of leprosy, there were 42.9% cases were of tuberculoid leprosy, 35.7% cases were of lepromatous leprosy. Indeterminate, borderline forms, and lepra reaction constituted remaining cases. In our study, 14.28% of patients showed positive family history of leprosy.

In the study by Choudhury, 52% cases were of tuberculoid leprosy and 23.4% cases were of lepromatous leprosy. In a study in Iran, the most common form of disease was lepromatous leprosy.[13]

In a study by Jindal et al.,[11] 33.12% of cases had lepromatous leprosy and 5.52% of cases had tuberculoid leprosy. In another study, both lepromatous and tuberculoid leprosy forms presented with a frequency of 27.8%.[14]

The finding suggests that variation between different forms of leprosy and male: female ratio is related to different geographical area.

In our study, out of 13 cases of noninfectious papulosquamous disease, 8 cases (61.5%) were of lichen planus (LP). Most cases of LP belong to Indian subcontinent, suggesting that children of South Asian origin are most susceptible.[15] Females appear to be more commonly affected than males.[16] According to Handa and Sahoo, in childhood LP, male: female is 1.1:1; while in our study, we found it to be 1:1.6. Although natural history and clinical and histopathological features of LP are similar to adults, still scalp, hair, and nail involvement are not common in childhood LP.[17]

In our study, out of all noninfectious papulosquamous disease, 3 cases (23.12%) were of lichenoid reaction and 2 cases (15.38%) were of acrodermatitis verruciformis of Hopf.

Pyogenic granuloma is the most common vascular tumor of infancy and childhood. Excision biopsy followed by curettage is recommended in pyogenic granuloma for the diagnostic and therapeutic purpose.[18] In our study, out of six cases of vascular tumor and malformation, four cases (66.6%) were of pyogenic granuloma.

Out of 6 cases of nevi, 2 cases (33.3%) were of nevus sebaceous of Jadassohn. It typically occurs on the face and scalp.[19] Our both the patients had nevus over the scalp. Single case (16.83%) each of melanocytic nevi, halo nevus, nevus depigmentosus, and inflammatory linear verrucous epidermal nevus has been found in our study.

In this study out of 7 connective tissue disorders 3 cases (42.85%) were of Lichen sclerosus et atrophicus and 3 cases (42.85%) were of perforating dermatoses, In which 2 cases were of reactive perforating folliculitis and 1 case of kyrle's disease.[20] Both the patients (100%) were female.

We found single case of systemic lupus erythematosus. In children, it occurs between the age of 3 and 15 years with girl predominance at a ratio of 4:1.[21]

Viral infections are common in school going children. In our study, out of 6 cases of viral disease, 2 cases (33.3%) were each of molluscum contagiosum and wart. We found only 1 case each of epidermodysplasia verruciformis and herpes simplex.

Overall female: male ratio in our study is 1.3:1. It may be related to gender bias in society which is still prevalent in the 21st century.

Out of 85 skin biopsies, five biopsies were not showing any histopathological changes which can correlate with clinical diagnosis.

The difficulties in making the histological diagnosis are best explained by Elliot foucar's criteria which are as following:[22]

  1. The information required to make the diagnosis is frequently incomplete at some level or at multiple levels
  2. The specificity studies to determine the prevalence of criteria in diagnostically challenging cases are frequently not available.



  Conclusion Top


Although histopathology remains the gold standard for most dermatologic diagnoses, it must be recognized that not all lesions are amenable to definitive“specific” histologic diagnosis. Sometimes, however, histopathology can contribute by ruling out an important diagnosis even though an exact diagnosis cannot be made.

In many cases, although the histopathological findings are not specific to arrive at a particular diagnosis, still many skin lesions can be diagnosed by histopathological study of skin biopsies and leprosy is the most commonly encountered skin disease in the routine practice.

The obvious diagnostic limitations of histology extend to infectious and neoplastic process. In difficult lesions, the clinical usefulness of histology may be aided by effective communication between clinician and pathologist with appropriate attention to the clinician and epidemiologic context of the lesion under the study.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.

 
  References Top

1.
Thappa DM. Common skin problems in children. J Const Pediatr 2002;69:701-6.  Back to cited text no. 1
    
2.
Federman DG, Reid M, Feldman SR, Greenhoe J, Kirsner RS. The primary care provider and the care of skin disease: The patient's perspective. Arch Dermatol 2001;137:25-9.  Back to cited text no. 2
    
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Elder DE, Murphy GF, Elenitsas R, Jhonson BL Jr., Xu X. Introduction to dermatopathologic Diagnosis. In: Elder DE, Murphy GF, Elenitsas R, Jhonson BL Jr., Xu X, editors. Lever's Histopathology of Skin, 10th ed. Walter Kluwer/ Lippincott williiams & wilkins; 2009. p. 1-3.  Back to cited text no. 3
    
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Werner B. Skin biopsy with histopathologic analysis: Why? what for? how? part II. An Bras Dermatol 2009;84:507-13.  Back to cited text no. 4
    
5.
Shah SN, Histopathological analysis of skin biopsies - A study of three years. In Indian medical association, Gujarat state Branch, Gujarat medical Journal 2013;8(2):67-70.  Back to cited text no. 5
    
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7.
Harrison PV. A guide to skin biopsies and excisions. Clin Exp Dermatol 1980;5:235-43.  Back to cited text no. 7
    
8.
Luna LG. Techniques for preparation of skin for histopathology. In: Graham JH, Johnson WC, Helwig EB, editors. Dermal Pathology. New York: Hamper & Row; 1972. p. 47-71.  Back to cited text no. 8
    
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Elentsas R, Van Belle P, Elder D. Laboratory methods. In: Elder D, Elenitsas R, Jaworsky C, Johnson B, editors. Lever's Histopathology of the Skin. 8th ed. Philadelphia, PA: Lippincott Raven; 1997. p. 51-60.  Back to cited text no. 9
    
10.
Choudhury AM. Leprosy in Bangladesh, 1984-88. Nihon Rai Gakkai Zasshi 1991;60:128-31.  Back to cited text no. 10
    
11.
Jindal N, Shanker V, Tegta GR, Gupta M, Verma GK. Clinico-epidemiological trends of leprosy in Himachal Pradesh: A five year study. Indian J Lepr 2009;81:173-9.  Back to cited text no. 11
    
12.
Lal S, Mahalingam C, Garg BR. Epidemiology of leprosy in rural population of Pondicherry. Lepr India 1982;54:677-84.  Back to cited text no. 12
    
13.
Golfurushan F, Sadeghi M, Goldust M, Yosefi N. Leprosy in Iran: An analysis of 195 cases from 1994-2009. J Pak Med Assoc 2011;61:558-61.  Back to cited text no. 13
    
14.
Melão S, Blanco LF, Mounzer N, Veronezi CC, Simões PW. Epidemiological profile of leprosy patients in the extreme south of Santa Catarina between 2001 and 2007. Rev Soc Bras Med Trop 2011;44:79-84.  Back to cited text no. 14
    
15.
Balasubramaniam P, Ogboli M, Moss C. Lichen planus in children: Review of 26 cases. Clin Exp Dermatol 2008;33:457-9.  Back to cited text no. 15
    
16.
Boyd AS, Neldner KH. Lichen planus. J Am Acad Dermatol 1991;25:593-619.  Back to cited text no. 16
    
17.
Handa S, Sahoo B. Childhood lichen planus: A study of 87 cases. Int J Dermatol 2002;41:423-7.  Back to cited text no. 17
    
18.
Mathes EF, Frieden IJ. Vascular tumors. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K, editors. Fitzpatrick's Dermatology in General Medicine. 8th ed. McGrawhill; 2012. p. 1456-69.  Back to cited text no. 18
    
19.
Kovich O, Hale EK. Nevus sebaceus. Dermatol Online J 2005;11:16.  Back to cited text no. 19
    
20.
Powell J, Wojnarowska F. Childhood vulvar lichen sclerosus: An increasingly common problem. J Am Acad Dermatol 2001;44:803-6.  Back to cited text no. 20
    
21.
James WD, Elston DM, Berger TG. Connective tissue disease. In: James WD, Elston DM, Berger TG, editors. Andrew's Disease of Skin Clinical Dermatology. 11th ed. Elsevier saunders; 2011. p. 155-81.  Back to cited text no. 21
    
22.
Foucar E. Error identification: A surgical pathology dilemma. Am J Surg Pathol 1998;22:1-5.  Back to cited text no. 22
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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