Harnessing Digital Pathology Tools to Distinguish Hand Eczema From Palmar Psoriasis: A Quantitative Approach

BACKGROUND: Distinguishing hand eczema from palmar psoriasis is a common diagnostic challenge due to overlapping clinical and histopathological features. OBJECTIVE: This study aimed to validate morphological and immunohistochemical criteria for differentiating these two conditions using the digital pathology tools QuPath and ImageJ. METHODS: One hundred forty-two histological samples with confirmed clinical diagnoses were stained with hematoxylin and eosin and subjected to immunohistochemical staining for CD3, CD15, CD20, CD123, S100, and PHH3. The samples were digitized for analysis. QuPath was used to automate annotation, segment epidermal layers, and measure rete ridge elongation, width, and suprapapillary epidermal thickness. Immunohistochemical markers were also analyzed using QuPath. ImageJ was employed to quantify spongiosis using color thresholding techniques. RESULTS: Suprapapillary epidermal thickness was significantly lower in psoriasis compared to eczema (p < 0.001; AUC = 0.72). Rete ridge elongation (p = 0.002; AUC = 0.704) and width (p < 0.001; AUC = 0.698) also showed significant differences. Furthermore, hypogranulosis was more pronounced in psoriasis (p = 0.012; AUC = 0.602), while S100-positive cells in the epidermis were more commonly observed in eczema (p = 0.013; AUC = 0.583). CONCLUSION: Quantitative assessment of suprapapillary epidermal thickness and rete ridge morphology offers a reliable and objective method for differentiating palmar psoriasis from hand eczema, enhancing diagnostic accuracy.