Help understanding skin biopsy?

[Spartan114]

What does this skin biopsy report likely imply:

Sections show skin with patchy parakeratosis and regular (psoriasiform) epidermal hyperplasia with loss of the
granular layer. There is mild spongiosis and accumulation of neutrophils in the stratum corneum focally in an area with
parakeratosis.
There is subadjacent mild superficial perivascular lymphocytic formation.
GMS stain is negative for
Tungal organisms/ There is no increase in eosinophils.

-the report reads as “psoriasiform dermatitis with features that could be compatible with psoriasis” bud the dermatologist nurse said that it’s also missing some key features expected with psoriass. Also spongiosis is uncommon in psoriasis. The dermatologist is taking the route of ‘well topical steroids treat all these inflammatory skin conditions so just them’ but psoriasis comes with health risks eczema and seb derm doesn’t. So I want to know. Basically raised red dry flaky lesions that are well defined started in groin and slowly grew to encompass entire scrotum and anal area. Not really itchy unless I sweat. Then spot on scalp appeared. Very small and tiny spot on face. No other locations. When I say this spread slow I mean it’s been 6 years and still covered less than 3% of my body. But there’s been no ‘flares’ or remission. Looking into it what the nurse said seems true; these biopsies have a lot of overlap and seb derm, psoriasis and eczema can all basically look identical even under a microscope.

What are your thoughts?

[Sara_MHModerator]

Hello and welcome to the forum. We're glad you found us!  Sorry for a delay in answering your question though.  Have you seen your dermatologist at this point to give you feedback on your report. We'd love to know what the turn out was from your doctor and the explanation that they gave you.   It would be really helpful for others. Medical reports could be so much easier to read with a word key, wouldn't they?  You do have a good grasp on this for as you've dealt  with it for so long.  

Some people have more than one thing going on as well. For the spots on your head, trying the two types of shampoos could be beneficial.  Nizoral helps control things as it has ketoconaozole. Bumps on scalp caused by these things can diminish with this shampoo. T Gel  can work for psoriasis. Both easy to try. Perhaps you have.

It's actually my understanding that moderate to severe psoriasis can result in spongiosis.  If you haven't read it, this article is helpful. You can copy and paste it into your browser. https://www.sciencedirect.com/topics/medicine-and-dentistry/spongiosis

Any update of your situation would be much appreciated!