Publication protocol
The selected formalin-fixed paraffin-embedded tissues from each biopsy specimen were cut into 4-micron sections and then mounted on glass slides. For the first time, they were stained by hematoxylin and eosin staining. The clinical diagnosis of psoriasis and psoriasiform dermatitis was done by dermatologists who were blind to the results of histopathology. The histopathological diagnosis was made by a dermatopathologist who was blind to the clinical diagnosis. The criteria used for histopathological diagnosis of psoriasis were hyperkeratosis with confluent parakeratosis, regular acanthosis, lack of granular layer, supra papillary thinning, Munro-Sabouraud micro abscess, high mitotic rate in the epidermis, dilated tortuous capillaries in papillary dermis, and the presence of T-lymphocyte infiltration in the dermis. The selected cases had most of the criteria. The psoriasiform dermatitis cases included chronic eczema, lichen simplex chronicus, pityriasis rubra pilaris, and pityriasis rosea, and they were diagnosed according to the criteria of dermatopathology textbooks, none of which had the main criteria of psoriasis [27]. The diagnosis was confirmed by a dermatopathologist. Then, immunohistochemistry was done. Primary antihuman antibodies against P53 protein (BioGenex, clone DO7, Fremont, CA, USA), Ki-67 (DAKO, clone MIB-1, Santa Clara, CA, USA) and CD34 (BioGenex, clone QBEND/10, Fremont, CA, USA), were used, according to the manufacturer protocols. Positive control samples for biomarkers were received from former strongly positive samples of papillary endothelial hyperplasia, high grade lymphoma and breast ductal carcinoma for CD34, Ki-67, and P53, respectively. The percentage of stained cells was estimated in high power field (×400) and divided as ≥6 blood vessels in stained papillary dermis were positive for CD34 and ≥25% of epidermal cells for Ki-67 and P53 were positive. In the case of P53 and Ki-67, all the keratinocytes with stained nuclei were estimated in high power fields and an average of positivity percentage was taken on the agreement of dermatopathologist and assistant. For evaluation of CD34, all of the high power fields immediately under epidermis were screened for separated vessels with open lumen and an average of the number of separated vessels was taken on the agreement. Cut-off points of 25% for P53 and Ki-67 was considered according to literature [19, 28]. Regarding CD34 evaluation, different methods are reported in the literature, and with this in mind, we considered 6 vessels as cut-off point of positivity [29].
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