Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

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Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
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Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




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Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : September | Volume : 16 | Issue : 9 | Page : EC10 - EC15 Full Version

Evaluation of Histomorphological Spectrum of Skin Lesions at a Teaching Institute in Agra: A Cross-sectional Study


Published: September 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/56863.16836
Chandrakanta, Pooja Nagayach, Lalit Kumar, Deepak Rawal, Prashant Singh, Harendra Kumar, Yatendra Chahar

1. Professor, Department of Pathology, S.N. Medical College, Agra, Uttar Pradesh, India. 2. Assistant Professor, Department of Pathology, S.N. Medical College, Agra, Uttar Pradesh, India. 3. Senior Resident, Department of Pathology, S.N. Medical College, Agra, Uttar Pradesh, India. 4. Junior Resident, Department of Pathology, S.N. Medical College, Agra, Uttar Pradesh, India. 5. Assistant Professor, Department of Pathology, S.N. Medical College Agra, Agra, Uttar Pradesh, India. 6. Professor, Department of Pathology, S.N. Medical College, Agra, Uttar Pradesh, India. 7. Assistant Professor, Department of Skin and Venereal disease, S.N. Medical College, Agra, Uttar Pradesh, India.

Correspondence Address :
Prashant Singh,
Department of Pathology, Sarjini Naidu Medical College, Agra, Uttar Pradesh, India.
E-mail: drprashant4488@gmail.com

Abstract

Introduction: The skin is the largest organ system in humans. Different skin diseases consist of non specific, non infectious and infectious diseases to various neoplastic lesions. Dermatological lesions are commonly encountered in all countries and it encompasses a wide spectrum, varies from country to country and various regions within a country and influenced by sex, age and associated systemic disorders, economy, literacy, racial and social customs. The clinical presentation is restricted to only a few changes such as hyperpigmentation, hypopigmentation, macules, papules, nodules and few others. However, the spectrum of histopathology of skin disorders is varied. Accurate diagnosis of skin disorders is of utmost importance as treatment is varied for different skin disorders presenting with the similar clinical lesions.

Aim: To study histomorphological spectrum and distribution of skin lesions.

Materials and Methods: This hospital-based cross-sectional study was conducted in Department of Pathology in collaboration with Department of Skin and Venereal Diseases, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India, over a period of two years from September 2019 to August 2021. The biopsy sample taken from clinically diagnosed skin lesions sent to histology laboratory in 10% formalin. Sample was fixed in 10% neutral buffered formalin over a period of 12 to 24 hours. Paraffin wax blocks were made and 3-4 micrometer sections were taken and stained with Haematoxylin and Eosin (H&E) stain and histology was studied under microscope. Special stains such as Ziehl-Neelsen (Z-N) stain and Fite stain were done, whenever required. Data was entered in Microsoft Excel excel and descriptive data was obtained.

Results: Out of total 105 cases, the maximum patients were of 21-30 years of age group 30 (28.57%) cases followed by 11-20 years of age group 25 (23.81%) cases with male and female ratio M:F=1.5:1. In this study, out of total 105 cases, the most common site involved was trunk in 42 (42%) cases followed by upper limb in 25 (23.81%) cases. The most common skin lesions were non infectious 70 (66.67%) cases, followed by infectious disease 22 (20.95) cases. In non infectious papulosquamous diseases group found 25 (23.81%) cases followed by vesiculobullous and vesiculopustular diseases group 24 (22.86%) cases. Infectious diseases were seen in 22 (20.95%) cases, out of which bacterial diseases being most common in 19 (18.10%) cases followed by parasitic infection 2 (1.90%) cases.

Conclusion: According to the findings of the present study the major cases of skin lesions requiring biopsy in developing countries is still psoriasis in non infectious papulosquamous diseases group. Tuberculosis and leprosy in infectious diseases category were being the leading cause of morbidity.

Keywords

Genodermatoses, Non infectious, Papulosquamous, Pemphigus vulgaris, Tuberculosis

The skin is the largest organ of the integumentary system in human (1). Different skin diseases comprise of non specific, non infectious and infectious diseases to various types of benign and malignant tumorous (neoplastic) lesions. Dermatological lesions are commonly encountered in all countries and it encompasses a wide spectrum, varies from country to country and various regions within a country. This variation is also influenced by sex, age and associated systemic disorders, economy, literacy, racial and social customs. Its prevalence ranges from 6.3-11.16% (2). Many of the skin lesions are diagnosed clinically based on the history and examination of the lesions. However, some of them require additional simple diagnostic procedures to make final diagnosis such as potassium hydroxide preparation, Tzanck smear, examination under wood’s lamp and skin biopsy in around 1.3% of patients (2).

The histomorphology of skin disorders shows wide spectrum, however the clinical presentations are very few like hypopigmentation, hyperpigmentation, macules, papules, nodules and few others (3). Accurate diagnosis of skin disorders is of utmost importance as treatment is varied for different skin disorders presenting with the similar clinical lesions (4). Histopathological study required for definitive diagnosis and identifying causative agent with special stains wherever feasible, help clinicians to decide the appropriate management and clinical intervention (2). The present study was conducted to study histomorphological spectrum of skin lesions and to evaluate histopathological diagnosis of skin lesions in different age groups, sex and site wise distributions and to find out frequency of various dermatological disorders in the tertiary care teaching hospital in Agra.

Material and Methods

This hospital-based cross-sectional study was conducted in Department of Pathology in collaboration with Department of Skin and Venereal diseases, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India over a period of two years from September 2019 to August 2021. Ethical clearance was obtained from Institutional Ethical Committee. (Letter No. IEC/2022/117). The study was carried out on skin biopsies of patient’s of all age group, coming to the histopathology lab and all cases coming during the study period. A total of 105 cases were selected as sample size on the basis of inclusion and exclusion criteria.

Inclusion and Exclusion criteria: All skin biopsies that showed definite signs of any specific pathology received in histopathology lab of the Department of Pathology during the study period were included. Inadequate, inconclusive and autolysed skin biopsies that did not show definite signs of any specific pathology were excluded from this study.

Study Procedure

The biopsy sample taken from clinically diagnosed skin lesions were sent immediately to histology laboratory in 10% formalin. Clinical history and relevant data were recorded. Sample was fixed in 10% neutral buffered formalin over a period of 12 to 24 hour. Paraffin wax blocks were made and 3-4 micrometer sections were taken and stained with H&E stain and histology was studied under microscope. Special stains like Z-N stain, modified Z-N Stain (Fite stain) etc were done, whenever required. Relevant demographic data was obtained from requisition form provided with the specimens.

Statistical Analysis

Data was entered in Microsoft word and descriptive data was obtained.

Results

In this study youngest patient encountered was eight years of age and oldest patient encountered was 70 years of age. The maximum patients were of 21-30 years of age group, 30 (28.57%) cases followed by 11-20 years of age group, 25 (23.81%) cases with male and female ratio M:F=1.5:1. Most common age group affected by infectious diseases was 21-30 years accounting 7 (6.67%) cases followed by 11-20 years 6 (5.71%) cases with male predominace (M:F=1.4:1) (Table/Fig 1)a. Most common age group affected by non infectious diseases was 21-30 years accounting 22 (20.95%) cases followed by 11-20 years 16 (15.24%) cases with Male predominace (M:F=1.26:1). Most common age group affected by neoplastic diseases was 51-60 years and 11-20 accounting for 3 (3.81%) cases each followed by 31-40 years and 41-50 years 2 (1.90%) cases with male predominace (M:F=5.5:1).

In this study, out of total 105 cases, the most common site involved was trunk in 42(40.00%) cases followed by upper limb in 25 (23.81%) cases, lower limb 23 (21.90%) cases and head and neck region in 15 (14.28%) cases. In non infectious papulosquamous diseases 25 (23.81%) cases, vesiculobullous and vesiculopustular diseases 24 (22.86%) cases, pigmentary diseases 3 (2.86%) cases, benign tumour 10 (9.52%) cases, trunk being the most common site to be involved. In infectious diseases 22 (20.95%) cases, connective tissue diseases 5 (4.77%) cases, upper limb being the most common site to be involved. In non infectious Inflammatory diseases 11 (10.48%) cases, lower limb being the most common site to be involved. In malignant tumour 3 (2.86%) cases, head and neck the most common site to be involved. In genodermatoses 2 (1.90%), one case in upper limb and one case in lower limb (Table/Fig 1)b.

In this study, out of total 105 skin lesions, most common skin lesions were non infectious 70 (66.67%) cases, followed by infectious disease 22 (20.95) cases and neoplastic lesion 13 (12.38%) cases (Table/Fig 1)c.

In this study, out of 105 cases, the most common type of skin lesions were of non infectious papulosquamous diseases group 25 (23.81%) cases, in which psoriasis 11 (10.48%) cases being most common followed by vesiculobullous and vesiculopustular diseases group 24 (22.86%) cases, in which pemphigus vulgaris being most common in 6 (5.71%) cases, infectious diseases in 22 (20.95%) cases, non infectious inflammatory diseases in 11 (10.48%) cases, benign tumour in 10 (9.52%) cases, malignant tumour in 3 (2.86%) cases, pigmentary diseases in 3 (2.86%) cases, and connective tissue diseases in 5 (4.77%) cases.

In this study, out of 105 cases, infectious diseases were seen in 22 (20.95%) cases, in which bacterial diseases being most common in 19 (18.10%) cases followed by parasitic infection in 2 (1.90%) cases and viral infection in 1 (0.95%) case. In Infectious disease, most common histological diagnosis was tuberculosis and leprosy with 9 (8.57%) cases each (Table/Fig 2)a, (Table/Fig 2)b, (Table/Fig 2)c. There was only one (0.95%) case of Verruca vulgaris in viral infection. In parasitic infection with total 2 (1.90%) cases, there was single case each of crusted scabies (Table/Fig 2)d and cutaneous leishmaniasis.

In this study, 1 (5.56%) case out of nine cases of tuberculosis were found AFB positive on ZN stain and five (27.78%) cases out of nine cases of leprosy were found AFB positive on Fite stain.

In this study, out of 105 cases, non infectious inflammatory diseases were seen in 11 (10.48%) cases. In which, the most common histological diagnosis was Polymorphic light eruption 5 (4.76%) cases followed by 2 (1.90%) cases each of erythema nodosum and non caseating granulomatous lesion and 1 (0.95%) case each of granulomatous lesion and granuloma annulare (Table/Fig 3)a, (Table/Fig 3)b.

In this study, out of 105 cases, non infectious papulosquamous diseases were seen in 25 (23.81%) cases. In which, the most common histological diagnosis was psoriasis 11 (10.48%) cases followed by 5 (4.76%) cases of Lichen planus 3 (2.86%) cases each of pityriasis rubra pilaris pityriasis Lichenoides and 1 (0.95 %) case each of Parapsoriasis, Pityriasis rosea, Lichenoid keratosis (Table/Fig 4)a-(Table/Fig 4)d.

In this study, 2 (1.90%) cases of genodermatoses were seen, each one of Acrokeratosis verruciformis and Urticaria pigmentosa respectively.

In this study, out of 105 cases, vesiculobullous and vesiculopustular diseases were seen in 24 (22.86%) cases, in which Pemphigus vulgaris being the most common histological diagnosis in 6 (5.71%) cases followed by 4 (3.81%) cases of Pemphigus foliaceous, 3 (2.86%) cases of Dermatitis herpetiformis 2 (1.90 %) cases each of Bullous pemphigoid, endogenous dermatitis, Lichen simplex chronicus and 1 (0.95%) case each of spongitic dermatitis, contact dermatitis, atopic dermatitis, nummular eczema, subcorneal pustular dermatosis (Table/Fig 5)a-(Table/Fig 5)c.

In this study, out of 105 cases, pigmentary diseases were seen in 3 (2.86%) cases, in which 2 (1.90%) cases of post inflammatory hyperpigmentation and 1 (0.95%) case of intradermal nevus (Table/Fig 6). All three cases were seen in males.

In this study, out of 105 cases, connective tissue diseases were seen in 5 (4.76%) cases, in which, 2 (1.90%) cases of morphea and 1 (0.95%) case each of Lichen sclerosus et atrophicus, dermatomyositis and Discoid Lupus Erythematosus (DLE) (Table/Fig 7)a,b.

In this study, out of 105 cases, neoplastic diseases were seen in 13 (12.38%) cases. Out of which, benign tumours 10 (9.52%) cases were more common than malignant lesions 3 (2.86%) cases. In benign tumour the most common histological diagnosis was epidermoid cyst 4 (3.81%) cases followed by dermoid cyst and lipoma in 2 (1.90%) cases each and 1 (0.95%) case each of seborrheic keratosis and lymphangioma circumscriptum (Table/Fig 8)a, (Table/Fig 8)b. In malignant tumours, there were 2 (1.90%) cases of squamous cell carcinoma and 1 (0.95%) case of keratoacanthoma (Table/Fig 8)c, (Table/Fig 8)d.

The variations in the present study as compared to studies carried out elsewhere in the past could be due to difference in the geographical distribution of the several aetiological factors responsible for causation of these conditions.

Discussion

Skin lesions are due to disparity in homeostasis that results in various conditions such as wrinkles hair loss, rashes, blisters and life threatening cancers. All the skin lesions may not required biopsy but for the proper diagnosis and identification of causative agents, dermatologist used to do it (5). The pattern of skin diseases are variable depending on economy, education level, variation in climate, primary health care facilities, industrialisation and variation in religious and cultural factors (6). Skin lesions are heterogeneous with a wide clinical and histopathological spectrum. Histopathological examination is the gold standard technique for diagnosing skin lesions. However, good clinical history, a close histopathological examination of the skin biopsy, clinicopathological correlation is essential for making final diagnosis so that the appropriate treatment can met (7). Special stains in conjunction with histopathological examination may also be required to reach final aetiological diagnosis (7). Skin biopsy is a simple outpatient procedure that helps in the confirmation of the clinical diagnosis (8).

The present study was aimed to study histomorphological spectrum of skin lesions, the aetiology of skin lesions using special stains like ZN stain, Fite stain as and when required and to study the age wise prevalence of different aetiologies of skin lesions. Biopsy specimen is expected to provide a fairly good estimate of patterns of skin disorders.

In this study, youngest case was seen in eight years of age and the oldest case encountered was 70 years of age. The present study encountered patient’s age between 1st to 7th decades, which is concordant with Mamatha K. et al., Singh S. et al., Agarwal D et al., Narang S et al., and Kafle SU et al., (2),(9),(10),(11),(12). However, Ayesha N et al., Mehar R. et al., Yalla ASD et al., George VP et al., Deepthi KN et al., Gaikwad SL et al., Bhardwaj V et al., Sushma C, Gupta P et al., found patients from 1st to 8th decade and Gulia SP et al., Bezbaruah R et al., Adhikari RC et al., found patients in 1st to 9th decade of life (1),(3),(6),(8),(13),(14),(15),(16),(17),(18),(19),(20).

In this study, maximum numbers of cases were found in 21-30 years age group (28.57%) followed by 11-20 years age group (23.81%), which is comparable with different studies and different age group being the most common age group in other studies (Table/Fig 9).

In this study, male predominance with male to female ratio of 1.5:1 was found and that was in concordance with other studies (1),(3),(4),(9),(10),(11),(13),(14),(16),(17),(18),(20),(21),(22). While it was not concordant with the findings in the studies by with Bezbaruah R et al., (20), Mamatha K et al., Kafle SU et al., and Gulia SP et al., as they found female predominance (2),(12),(19).

In this study, the most common site of lesion was trunk (40%) followed by upper limb (23.81%), while Bezbaruah R et al., (57.52% cases), Bhardwaj V et al., (33% cases); Chalise S et al., (29.32% cases) and Adhikari RC et al., (30.2% cases) found head and neck region being the most common site (5),(6),(8),(20). This could be due to the geographical differences of the study place.

In this study, non neoplastic lesions including infectious and non infectious disease i.e. 22 (20.95%) cases and 70 (66.67%) cases respectively outnumbered neoplastic lesions 13 (12.38%) cases which was found concordant with some studies (2),(3),(4),(6),(8),(9),(10),(12),(15),(16),(18),(22). This study was found non concordant with Gaikwad SL et al., (58.0% cases), Bezbaruah R et al., (81.42% cases), Yadav S et al., (68.4% cases) as they found overall neoplastic lesions outnumbered non neoplastic lesions with epidermal cyst being most common histological diagnosis (1),(20),(21).

In this study, the most common type of skin lesion group was non infectious papulosquamous diseases 25 (23.81%) cases followed by Vesiculobullous and vesiculopustular diseases 24 (22.86%) cases and Infectious diseases 22 (20.9%) cases which was concordant with some studies and however other found different type of skin lesion being most common (Table/Fig 10). In this study, the second most common type of skin lesion group was vesiculobullous and vesiculopustular diseases (22.86%) cases, while non infectious papulosquamous diseases was second most common in study of Kafle SU et al., (18.01% cases) and neoplastic lesions were second most common in George VP et al., (22.4% cases) and vesiculobullous lesion were second most common in study of Patel A et al., (15.0% cases) (4),(12),(15).

In this study, psoriasis 11(10.48%) cases was most common histological diagnosis followed by tuberculosis and leprosy 9 (8.57%) cases in each and different studies found different histological type being the most common histological diagnosis (Table/Fig 10). In this study, among neoplastic lesions, epidermal cyst was found most common histological diagnosis in 30.76% cases concordant with Bharadwaj V et al., (44.56% cases) (8). However, Achalkar GV et al., (52.8% cases), Ayesha N et al., found squamous cell carcinoma, Agarwal D et al., (30.43% cases) found basal cell carcinoma and Gupta P et al., (20.75% cases) found lipoma as most common histological diagnosis among the neoplastic lesions (10),(13),(18),(22). So meticulous histopathological examination combined with awareness in mind regarding prevalence of diverse skin lesions can help in correct diagnosis.

Limitation(s)

Limitations of present study was lack of clinicohistological correlation and absence of follow-up.

Conclusion

Present study was conducted to study histopathological spectrum of skin lesions, aetiology of skin lesions using special stain and age, sex and site wise prevalence of skin lesions. The major cases of skin lesions requiring biopsy in developing countries is still psoriasis in non infectious papulosquamous diseases group. Tuberculosis and leprosy in infectious diseases category were being the leading cause of morbidity. The age distribution pattern showed highest prevalence in 21-30 years age group i.e. 28.57%. The sex distribution pattern showed males preponderance. The non infectious papulosquamous diseases were the most common type of skin lesions.

References

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DOI and Others

DOI: 10.7860/JCDR/2022/56863.16836

Date of Submission: Apr 04, 2022
Date of Peer Review: Apr 19, 2022
Date of Acceptance: Jul 14, 2022
Date of Publishing: Sep 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: No
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Apr 11, 2022
• Manual Googling: May 23, 2022
• iThenticate Software: Jul 14, 2022 (15%)

Etymology: Author Origin

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