Context: Clinico-pathological features of each entity of granulomatous reaction have been evaluated independently. However, considerable clinical and histopathological overlap exists making it diagnostically challenging for the treating physician. We conducted this study, as there is paucity of data in this regard. Aims: To analyze demographic parameters in patients with granulomatous skin diseases and to detect level of clinicopathological concordance in the study group. Settings and Design: This is a prospective observational study of 105 cases of granulomatous skin lesions at a tertiary care centre in Gujarat. Methods and Material: Clinical diagnosis of granulomatous skin lesions was made by two dermatologists and skin biopsy was obtained in each patient. Correlation between clinical impression and histopathological findings was evaluated. Data were analysed using chi-squaretest. P value<0.005 was considered as significant. Results: There were 62 males (59%) and 43 females (40.9%) with Male to female ratio 1.44:1. Mean age was 32.59 years ± 14.46 SD. Concordance between initial clinical impression and histological diagnosis was found in 69 of 105 cases (65.7%) while 36 (34.2%) were in the discordant and undecided category. Most common type of granuloma was tuberculoid type (n=39,56.52%); Necrobiotic granuloma was detected in 5 cases(7.24%). Miscellaneous 20 cases (28.98%) included 19 cases of Hansen's disease and 1 case of papular xanthoma. In infectious diseases, Erythema Induratum and Hansen's disease were the entities with maximum amount of concordance that is 100% and 85.7% respectively; while in non infectious diseases, cases with Granuloma Annulare, granulomatous rosacea and Lupus Miliaris disseminatus Facei had 100% clinico pathological concordance. Conclusion: We observed that histopathology alone was not helpful in diagnosis of granulomatous tissue reaction all times, as variable histopathological patterns were observed. Use of other advanced diagnostic methods like PCR; rapid antigen detection etc. should be encouraged. Further studies with larger sample size are needed to confirm the findings and validate new clinical patterns.
