eMedicine Specialties > Dermatology > Papulosquamous Diseases
Parapsoriasis: Differential Diagnoses & Workup
Updated: Mar 13, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Differential Diagnoses
| Contact Dermatitis, Allergic | Pityriasis Lichenoides |
| Cutaneous T-Cell Lymphoma | Pityriasis Rosea |
| Nummular Dermatitis | Psoriasis, Guttate |
| Pityriasis Alba | Syphilis |
Workup
Laboratory Studies
- Complete blood cell count with differential: A high lymphocyte count or the presence of Sézary cells suggests MF/CTCL.
Procedures
- Skin biopsy with immunophenotyping analysis and gene rearrangement studies
Histologic Findings
Histopathology of small plaque parapsoriasis shows a mild superficial perivascular lymphocytic infiltrate with a nonspecific inflammatory infiltrate of CD4+ and CD8+ T cells. However, CD4+ T cells are predominant. The epidermis may show mild spongiosis, focal hyperkeratosis, scale crust, parakeratosis, and occasional exocytosis. Often the pattern is not diagnostic and is nonspecific. Lymphocytes are small and do not show atypical features.
In large plaque parapsoriasis, a superficial dermal inflammatory infiltrate consists predominantly of lymphocytes. Numerous lymphocytes abut the dermal epidermal junction and single lymphocytes can be observed in the epidermis. Lymphocytes are generally small and do not show atypical nuclei. Blood vessels are dilated, and melanophages can be present. The epidermis shows flattening of the rete ridges when epidermal atrophy is prominent on clinical examination. Acanthosis of the epidermis and irregular hyperkeratosis of the cornified layer are present. In contrast to small plaque parapsoriasis, spongiosis is absent.
Gene rearrangement studies can assist in excluding MF or CTCL.
More on Parapsoriasis |
| Overview: Parapsoriasis |
Differential Diagnoses & Workup: Parapsoriasis |
| Treatment & Medication: Parapsoriasis |
| Follow-up: Parapsoriasis |
| Multimedia: Parapsoriasis |
| References |
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References
Kikuchi A, Naka W, Harada T, Sakuraoka K, Harada R, Nishikawa T. Parapsoriasis en plaques: its potential for progression to malignant lymphoma. J Am Acad Dermatol. Sep 1993;29(3):419-22. [Medline].
Ackerman AB. If small plaque (digitate) parapsoriasis is a cutaneous T-cell lymphoma, even an 'abortive' one, it must be mycosis fungoides!. Arch Dermatol. May 1996;132(5):562-6. [Medline].
Burg G, Dummer R, Nestle FO, Doebbeling U, Haeffner A. Cutaneous lymphomas consist of a spectrum of nosologically different entities including mycosis fungoides and small plaque parapsoriasis. Arch Dermatol. May 1996;132(5):567-72. [Medline].
Olsen E, Vonderheid E, Pimpinelli N, et al. Revisions to the staging and classification of mycosis fungoides and Sezary syndrome: a proposal of the International Society for Cutaneous Lymphomas (ISCL) and the cutaneous lymphoma task force of the European Organization of Research and Treatment of Cancer (EORTC). Blood. Sep 15 2007;110(6):1713-22. [Medline].
Baskan EB, Tunca B, Cecener G, et al. Analysis of p53 gene mutations in parapsoriasis. J Eur Acad Dermatol Venereol. Aug 2006;20(7):882-3. [Medline].
Wu K, Lund M, Bang K, Thestrup-Pedersen K. Telomerase activity and telomere length in lymphocytes from patients with cutaneous T-cell lymphoma. Cancer. Sep 15 1999;86(6):1056-63. [Medline].
Kreuter A, Bischoff S, Skrygan M, Wieland U, Brockmeyer NH, Stücker M. High association of human herpesvirus 8 in large-plaque parapsoriasis and mycosis fungoides. Arch Dermatol. Aug 2008;144(8):1011-6. [Medline].
Kim YH, Jensen RA, Watanabe GL, Varghese A, Hoppe RT. Clinical stage IA (limited patch and plaque) mycosis fungoides. A long-term outcome analysis. Arch Dermatol. Nov 1996;132(11):1309-13. [Medline].
Herzinger T, Degitz K, Plewig G, Rocken M. Treatment of small plaque parapsoriasis with narrow-band (311 nm) ultraviolet B: a retrospective study. Clin Exp Dermatol. Jul 2005;30(4):379-81. [Medline].
Hofer A, Cerroni L, Kerl H, Wolf P. Narrowband (311-nm) UV-B therapy for small plaque parapsoriasis and early-stage mycosis fungoides. Arch Dermatol. Nov 1999;135(11):1377-80. [Medline].
Koh HK, Charif M, Weinstock MA. Epidemiology and clinical manifestations of cutaneous T-cell lymphoma. Hematol Oncol Clin North Am. Oct 1995;9(5):943-60. [Medline].
Rook AH, Heald P. The immunopathogenesis of cutaneous T-cell lymphoma. Hematol Oncol Clin North Am. Oct 1995;9(5):997-1010. [Medline].
Further Reading
Keywords
parapsoriasis, digitate dermatosis, parapsoriasis en plaque, acuta pityriasis lichenoides, chronica pityriasis lichenoides, small plaque parapsoriasis, large plaque parapsoriasis, mycosis fungoides, MF, cutaneous T-cell lymphoma, CTCL
Differential Diagnoses & Workup: Parapsoriasis