eMedicine Specialties > Dermatology > Papulosquamous Diseases

Parapsoriasis: Differential Diagnoses & Workup

Author: Henry K Wong, MD, PhD, Senior Professional Staff, Department of Dermatology, Henry Ford Hospital
Contributor Information and Disclosures

Updated: Mar 13, 2009

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

References

  1. 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].

  2. 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].

  3. 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].

  4. 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].

  5. 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].

  6. 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].

  7. 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].

  8. 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].

  9. 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].

  10. 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].

  11. 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].

  12. 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

Contributor Information and Disclosures

Author

Henry K Wong, MD, PhD, Senior Professional Staff, Department of Dermatology, Henry Ford Hospital
Henry K Wong, MD, PhD is a member of the following medical societies: American Academy of Dermatology, American Association of Immunologists, and Society for Investigative Dermatology
Disclosure: EISAI Consulting fee Speaking and teaching; Amgen Consulting fee Other; Abbott Labs Grant/research funds Other; Merck Honoraria Speaking and teaching

Medical Editor

Abby S Van Voorhees, MD, Assistant Professor, Director of Psoriasis Services and Phototherapy Units, Department of Dermatology, University of Pennsylvania School of Medicine, Hospital of the University of Pennsylvania
Abby S Van Voorhees, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, National Psoriasis Foundation, Phi Beta Kappa, Sigma Xi, and Women's Dermatologic Society
Disclosure: Amgen Honoraria Consulting; Astellas Grant/research funds Other; Abbott Honoraria Consulting; Genentech Honoraria Consulting; Incyte Grant/research funds Other; Centocor Honoraria Consulting; Warner Chilcott  Consulting; Merck Salary Review panel membership

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

Christen M Mowad, MD, Associate Professor, Department of Dermatology, Geisinger Medical Center
Christen M Mowad, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and Phi Beta Kappa
Disclosure: Nothing to disclose.

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds None; Genentech Consulting fee Consulting; Centocor Consulting fee Consulting; Centocor Grant/research funds None; Covance Consulting fee Consulting; Shire  Consulting

Chief Editor

William D James, MD, Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System
William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology
Disclosure: elsevier Royalty Other; american college of physicians Honoraria Other

 
 
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