eMedicine Specialties > Dermatology > Papulosquamous Diseases

Parapsoriasis: Follow-up

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

Updated: Mar 13, 2009

Follow-up

Further Outpatient Care

  • Patients with small plaque parapsoriasis may have follow-up care every year unless new symptoms or changes in therapy indicate a need for reevaluation. Progression of lesions suggests a need for reevaluation by skin biopsy.
  • Large plaque parapsoriasis requires closer follow-up than small plaque parapsoriasis. When treating this disease, follow-up frequency is determined by the treatment modality used. Phototherapy requires an evaluation to response after every 8-12 visits or monthly. Patients using topical treatment need follow-up every 2-3 months. If patients remit or do not desire treatment, follow-up is still recommended to assess for recurrence or progression.

Complications

  • Development of contact dermatitis upon administration of topical chemotherapy agents

Prognosis

  • Small plaque parapsoriasis may persist in a stable pattern for years to decades and then resolve spontaneously. A small number of cases may progress to MF.
  • Large plaque parapsoriasis remains indolent for many years. The disease may progress to CTCL with transformation of lymphocytes from benign small size to larger atypical lymphocytes. The 5-year survival rate, however, still remains high and is greater than 90%.

Miscellaneous

Medicolegal Pitfalls

  • Parapsoriasis is relatively benign and may persist for many years. Provide follow-up in the case of large plaque parapsoriasis every 6 months because the disease may progress to CTCL.
 


More on Parapsoriasis

Overview: Parapsoriasis
Differential Diagnoses & Workup: Parapsoriasis
Treatment & Medication: Parapsoriasis
Follow-up: Parapsoriasis
Multimedia: Parapsoriasis
References
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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].

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Further Reading

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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

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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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