Harnessing Digital Pathology Tools to Distinguish Hand Eczema From Palmar Psoriasis: A Quantitative Approach

Area of Science:

• Dermatopathology
• Digital Pathology
• Histopathology

Background:

• Distinguishing hand eczema from palmar psoriasis presents a diagnostic challenge due to overlapping features.
• Accurate differentiation is crucial for effective treatment and management.

Purpose of the Study:

• To validate morphological and immunohistochemical criteria for differentiating palmar psoriasis and hand eczema.
• To leverage digital pathology tools (QuPath, ImageJ) for objective assessment.

Main Methods:

• Histological samples (n=142) underwent H&E and immunohistochemical staining (CD3, CD15, CD20, CD123, S100, PHH3).
• Digital analysis using QuPath for epidermal segmentation, rete ridge measurements, and marker quantification.
• ImageJ utilized for spongiosis quantification via color thresholding.

Main Results:

• Significantly lower suprapapillary epidermal thickness in psoriasis (p<0.001, AUC=0.72).
• Distinct differences in rete ridge elongation (p=0.002, AUC=0.704) and width (p<0.001, AUC=0.698).
• Psoriasis showed more hypogranulosis (p=0.012, AUC=0.602), while eczema had more S100+ epidermal cells (p=0.013, AUC=0.583).

Conclusions:

• Quantitative assessment of suprapapillary epidermal thickness and rete ridge morphology provides an objective diagnostic method.
• Digital pathology enhances the accuracy in differentiating palmar psoriasis from hand eczema.
• This approach aids clinicians in making more informed diagnostic decisions.