Ann Med. 2026 Dec;58(1):2749195. doi: 10.1080/07853890.2026.2749195. Epub 2026 Nov 2.
ABSTRACT
BACKGROUND: Hyperkeratotic palmoplantar lesions (HPPLs), primarily encompassing palmoplantar psoriasis (PPP) and hyperkeratotic palmoplantar eczema (HPKE), present a significant diagnostic challenge due to overlapping clinical morphological features. This study evaluates the diagnostic accuracy of dermoscopy as a non-invasive bridge between clinical evaluation and standard histopathology.
METHODS: An observational cross-sectional study was conducted on 44 adult patients presenting with clinically diagnosed HPPLs at a tertiary care center over an 18-month period. Patients underwent thorough clinical examination, dermoscopic evaluation (using a DermLite DL200 Hybrid), and a standard 4.0 mm punch biopsy for histopathological confirmation. Inter-method agreement and diagnostic concordance among the three modalities were analyzed using Cohen's kappa statistic.
RESULTS: The study cohort (mean age 40.32 years) was histopathologically confirmed to have psoriasis in 31 cases (70.45%) and eczema in 11 cases (25%). Dermoscopically, regularly distributed red dots and globules strongly indicated psoriasis (45.16% vs. 0% in eczema), whereas irregular vascular patterns predominated in eczema (54.55%). Concordance between dermoscopic and histopathological diagnoses was remarkably high, showing good agreement (81.81% concordance, κ = 0.652, p < 0.0001). Conversely, clinical-histopathological agreement was poor (56.82%, κ = 0.041), and clinical-dermoscopic agreement was fair (65.90%, κ = 0.350).
CONCLUSIONS: The findings of dermoscopy align closely with histopathology. Dermoscopy serves as an effective adjunctive tool to minimize reliance on invasive skin biopsies, rather than completely replacing them.
PMID:42973050 | DOI:10.1080/07853890.2026.2749195