Histopathological features and clinical variants of psoriasis in a tertiary care centre in western uttar Pradesh

ABSTRACT Background: Psoriasis is a chronic, immune-mediated, relapsing papulosquamous disorder with global prevalence and significant morbidity due to its chronic nature and systemic associations. Histopathological evaluation plays a vital role in confirming the diagnosis and identifying subtypes for optimal management. Objective: To identify clinical and histopathological features and assess histological parameters useful in subtyping variants of psoriasis. Methods: This prospective study was conducted over 18 months in the Department of Pathology at Muzaffarnagar Medical College, Uttar Pradesh. A total of 70 skin biopsy specimens with a clinical diagnosis or differential diagnosis of psoriasis were included. Histological features such as elongation of rete ridges, parakeratosis, suprapapillary thinning, Munro's microabscess, vascular dilatation, and inflammatory infiltrates were analyzed and correlated with clinical variants. Results: Among 70 histopathologically confirmed psoriasis cases, the most common clinical variant was chronic plaque psoriasis (94.2%). Male predominance (72.86%) was noted with peak incidence in the 21–30 years age group. Common histological features included vascular dilatation (97.1%), parakeratosis (94.2%), elongation of rete ridges (90%), and suprapapillary thinning (90%). Munro’s microabscesses and Kogoj pustules were noted in a minority. Two clinically suspected guttate psoriasis cases were reclassified histologically as plaque psoriasis. Conclusion: Histopathological examination remains indispensable in confirming psoriasis, especially when clinical presentations overlap with other dermatoses. Accurate identification of histological features aids in proper subtyping and informs treatment decisions