Clinico-pathological Consistency in the Diagnosis of Skin Disorders in a Tertiary Care Hospital in Southern Nigeria: A Descriptive Cross-Sectional Analysis

Abstract

Background: The histopathological examination of representative skin biopsy specimens is widely regarded as the gold standard for the resolution of dermatological diagnostic dilemmas, especially with good clinico-pathological correlation, and the skin biopsy is the dermatologists’ most requested investigation. Studies on the clinico-pathological consistency in the diagnosis of skin disorders from our part of the world are very rare. Objective: This study aimed at determining the consistency between the provisional clinical diagnosis and the histopathologiscal diagnosis of skin biopsy specimens. Materials and Methods: This study was carried out over a six-month period using specimens from the 58 patients who consented to skin biopsy during this time, and comparison was made between the provisional clinical diagnosis and the histopathological diagnosis. Results: Of the 58 subjects that participated in the study, 29 were males and 29 were females. Their ages ranged between 7 and 68 years, with a mean age of 37.3 years. The spectrum of histopathologically diagnosed disorders included skin tumours and tumour-like conditions (12 cases, 20.7%), psoriasiform disorders (10 cases, 17.2%), lichenoid disorders (9 cases, 15.5%), infectious disorders (8 cases, 13.8%), disorders of epidermal maturation and keratinization (7 cases, 12.1%), spongiotic disorders (7 cases, 12.1%), vesiculo-bullous disorders (3 cases, 5.2%), and others (3.4%). Overall, the histopathological diagnosis was consistent in 19 cases (32.8%), corroborative in 12 cases (20.7%), with clinico-pathological correlation, and inconsistent in 27 cases (46.6%), leading to the issuance of a completely new diagnosis. Conclusion: The observed degree of clinico-pathological inconsistency in the evaluation and diagnosis of skin disorders in our environment implies that skin biopsy for histopathological examination is highly valuable if patients are to be issued the appropriate diagnoses for the avoidance of inappropriate treatments. The contribution of histopathology to the accuracy of dermatological diagnosis is significantly enhanced by clinico-pathological corroboration.