Dermoscopy for differentiation of palmoplantar psoriasis and hyperkeratotic hand-foot eczema: a descriptive study

Palmoplantar psoriasis (PPP) and hyperkeratotic eczema (HPKE) are common and troublesome entities affecting the palms and soles. The diagnosis is made clinically, but differentiation is difficult; histopathology helps but is often impossible in daily practice. Dermoscopy is increasingly utilized to diagnose inflammatory disorders and has been used to differentiate PPP from HPKE. The present study was carried out to evaluate the role of dermoscopy in the differentiation of PPP and HPKE in a tertiary care center of eastern India. This hospital-based observational study included 20 patients with each of clinically diagnosed PPP and HPKE. Dermoscopy examinations were done, and the results were tabulated and summarized. Fisher’s exact test was employed to assess statistical significances in differences. Diffuse white and yellow scales were found in both PPP and HPKE without any significant difference. Brown orange globules, clustered dotted vessels, yellow, orange crusts, and perilesional scaling were found more in HPKE (P < 0.05). On the other hand, uniformly dotted vessels and background erythema were more characteristic of PPP (P < 0.05). The results of the current study had deviations from the results of studies done abroad, which can be ascribed to differences in skin color. Dermoscopy is a valuable tool to sort out diagnostic dilemmas in cases of PPP and HPKE. It should be used more commonly to gain more experience and information in the diagnosis of inflammatory dermatoses.