Introduction
The skin is the largest organ of the body, comprising of epidermis, dermis and hypodermis. Epidermis contains superficial lining epithelium. Dermis contains loose areolar tissue, blood vessels, sweat glands, sebaceous glands and root of hair follicles. Hypodermis contains mainly adipose tissue. Skin has important functions to perform like protection, temperature regulation and also metabolic.1 Among the out patients the patients with skin ailments form significant numbers and they constitute more numbers of hospital cases. They arise from the normal histological constituents of the skin. Different skin diseases comprise of non-specific, non infectious and infectious diseases to various types of benign and malignant tumorous (neoplastic) lesions. Vesiculobullous skin lesions are always the cause of concern to patients, clinicians and pathologists. Pemphigus vulgaris is an uncommon disease which is autoimmune in nature, but the most common among pemphigus group of skin diseases.2 Skin biopsy forms the fundamental basis for differentiation of similarly looking dermatological disorders and lesions, thereby giving valuable information to the pathologists to make a definitive diagnosis and more so to the dermatologist for better management of patients. Clinical diagnosis alone may not be conclusive many times and histopathology becomes a prime requisite for the definite diagnosis. Therefore, this study was designed to evaluate histopathology as an accurate diagnostic method for different types of non- neoplastic and neoplastic lesions of the skin and to correlate the clinical and histopathological findings of various skin lesions.3
Aims and Objectives
To confirm diagnosis and initiation of treatment. To study the histopathological spectrum of skin lesions at tertiary care hospital.To classify the most common disorders into their subtypes and thus asses the most common subtype prevalent in the surrounding community.4
Materials and Methods
A hospital-based study was conducted at P.D.U. Medical College, Rajkot, from August 2022 to July 2023. During this period, the department received a total of 374 skin biopsies. Relevant medical histories and other investigations were collected from each patient. Skin biopsies were received in histopathology department in 10% formalin with necessary clinical details obtained in histopathology requisition form. Specimens were processed in automated histokinette machine and pass through the steps of dehydration, clearing and impregnation, embedding in paraffin wax, blocks prepared of tissue, section cutting with microtome and tissue were taken on glass slide and stained with Hematoxyllin & Eosin stain. Special stains like ziehl-neelsen (Z-N stain), Periodic acid schiff (PAS) and fite-farraco stain also used whenever required.5, 4
Results
Out of 374 biopsies, 60% were from male patients while it was 40% from female patients, with a male: female ratio of 1.5:1 showing male predominance. The age of the patients ranged from 8 years to 76 years and the mean age was 38 years. On microscopic study, of cases were non neoplastic 98.4% lesions and 1.6% neoplastic lesions.3 Histopathological examination of the tissue was done so as to arrive at a definitive diagnosis. Most common histological spectrum was Dermatitis (28%), lepromatous leprosy 58.8%) was most commonly reported among the leprosy (27.3%). Then pemphigus vulgaris (49%) was the most commonly encountered vesicobullous lesions (25.7).6 In non-neoplastic lesion, commonest site was upper extremity, followed by back and lower extremity cases. In neoplastic lesion, commonest involved site was head and neck followed by lower extremity and trunk cases. In neoplastic disease, Squamous cell carcinoma (41.7%) is most common then basal cell carcinoma (33.3%).6, 7
Table 1
Spectrum of various skin lesions8
Table 2
Age and sex distribution of skin lesions9
|
Age group (years) |
No. of cases (Male) |
No. of cases (Female) |
Total |
Percentage (%) |
|
0-20 |
25 |
12 |
37 |
9.9 |
|
21-40 |
89 |
59 |
148 |
39.6 |
|
41-60 |
83 |
52 |
135 |
36.0 |
|
>60 |
30 |
24 |
54 |
14.5 |
|
Total |
227(60%) |
147(40%) |
374 |
100 |
Table 3
Table 4
Discussion
In the present study 374 skin biopsies were analysed over a period of 1 year in the department of pathology of tertiary health center was evaluated. It was observed in the present study that skin lesions were more often seen in younger age groups with 50% cases seen below 40 years age. In the present study, the male preponderance was noted in skin lesions with 60% skin lesions being diagnosed in males. Inflammatory lesions were most commonly encountered followed by leprosy. Lepromatous leprosy (58.8%) is the most common in leprosy (27.3%) in this study.13 In neoplastic disease, Squamous cell carcinom (41.7%) is most common then basal cell carcinoma (33.3%). In Vesico-bullous lesions, pemphigus vulgaris (49%) is the most common.15
Conclusion
Majority of skin lesions were found in younger individuals with males (60%) being affected more commonly than females (40%).9 Leprosy (27.3%) is followed by dermatitis (28%) was the most commonly diagnosed entities. Lepromatous leprosy is the most common in leprosy in this study.16 Pemphigus vulgaris (49%) in vesico-bullous lesions, the most common in our study. In neoplastic disease, Squamous cell carcinoma is most common than basal cell carcinoma. Histopatholoical examination of skin biopsies remain gold standard in the diagnosis of skin lesions having their different clinical presentation and histomorphology. This signifies the role of histopathology in management and prognosis of skin lesion.5, 4, 13
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