The papulosquamous skin disorders are a diverse set of conditions that constitute the most common diseases seen by dermatologists. There is a lot of overlap in the appearance and distribution of lesions, which makes diagnosis challenging. The skin, the body's largest organ, responds to pathogenic stimuli in a restricted number of ways. As a result, histological patterns in clinically distinct lesions may be similar. A thorough histological evaluation is considered the gold standard in diagnosing skin disorders, but it has limits, and without clinical information, a definitive specific diagnosis is often impossible. In many circumstances, a diagnosis might be made by comparing histopathological and clinical findings.A Prospective study was carried out in the Department of Dermatology from September 2019 to September 2021. Patients presenting with clinically papulosquamous disorder were photographed and a presumptive clinical diagnosis was made based on clinical features; which was confirmed by histopathological examination and correlation between clinical and histopathological findings was studied. The study included 202 patients in which clinico-histopathological correlation was done. In 88.11% cases a positive correlation was established whereas a negative correlation was obtained in 11.89%cases. Psoriasis constituted the highest cases 64(31.68%) followed by lichen planus 52(25.74%).Majority of the papulosquamous disorders have an overlapping clinical presentation as skin reacts in a limited pattern towards any pathologic stimuli. There is a need for clear clinical information and a description of the lesion to assist the histopathologist in arriving at a conclusive diagnosis, which is the gold standard, to overcome the associated complexity in diagnosing and commencing the right treatment. For a more accurate differentiation of various papulosquamous disorders, histopathology is very crucial for appropriate medical management. This is clearly seen and supported by the present study.
Background: Apremilast is an oral, selective phosphodiesterase-4 (PDE-4) enzyme inhibitor, approved by the US-FDA for management of moderate to severe plaque psoriasis. Apremilast belongs to class of drug that function by modulating pro-inflammatory cytokines and have a low molecular weight (<1 kD), identified as small molecules. Due to its convenience in administration via oral or topical route, adequate efficacy, great safety profile and low cost they are emerging as treatment choices in inflammatory dermatosis and other systemic inflammatory disorders. Material and Methods: A hospital based, prospective, interventional, cohort study was conducted on 78 patients with Chronic plaque psoriasis. Efficacy of Apremilast was studied in 38 patients receiving oral Apremilast with topical steroids in comparison to 36 patients who were given only topical steroids for 16 weeks. Patients were evaluated pre-treatment and then every 4 weeks for a period of 16 weeks and followed up to the 28th week for any adverse effects associated with apremilast therapy. Outcome was assessed on the basis of PASI score and clinical photographs. Side effects in both groups were recorded. Results: Primary endpoint (PASI75 and above) was achieved in 68.42% patients in group A. Among this patient's PASI 90 was achieved in 13.16% (n=5) and PASI 100 was obtained in 13.16% (n=5). In Group B, none of the patients achieved PASI 75. Most common side effects observed in group A were GI disturbances. No significant adverse effect was noted in group B. Conclusion: Apremilast has good efficacy and safety in patients with chronic plaque psoriasis. and is generally well tolerated which makes it possible to keep other immunosuppressants to be kept in reserve for more severe stages of disease. Our study supports the favorable benefit:risk profile of oral apremilast.
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