Parapsoriasis Treatment & Management

Updated: Oct 07, 2021
  • Author: Henry K Wong, MD, PhD; Chief Editor: Dirk M Elston, MD  more...
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Treatment

Approach Considerations

Parapsoriasis can be managed conservatively on the basis of symptoms, and often, topical treatment is effective. A novel treatment of parapsoriasis reported in 2018 is hydrogen-water bathing. This modality proposes water with increased reactive oxygen scavenging properties as the mechanism. In a small study in which parapsoriasis patients were bathed twice weekly over 8 weeks, four of six showed partial responses and two had complete remission. The treatment was well tolerated. [16]

Small plaque parapsoriasis

Small plaque parapsoriasis usually is asymptomatic. Treatment should be based on alleviation of symptoms associated with scaliness, and patients should be reassured of the benign self-limiting nature of the disease.

Emollients may be sufficient to treat scaliness; however, a trial of midpotency topical steroids (class 3-5) may lead to greater clinical responsiveness.

Phototherapy is effective in treating lesions that are widely scattered. Broad- or narrow-band UV-B can be effective and can lead to remission. [17, 18] More recalcitrant presentations can be treated with psoralen and long-wave ultraviolet radiation (PUVA).

Annual follow-up is recommended. An increase in the number of lesions, an increase in the size of lesions, or the development of induration or epidermal atrophy should prompt a repeat skin biopsy to consider a diagnosis of mycosis fungoides (MF) in evolution.

Large plaque parapsoriasis

Large plaque parapsoriasis should be treated, because treatment may prevent progression to MF (cutaneous T-cell lymphoma [CTCL]). Therapy includes mid- to high-potency topical steroids (class 2-4), topical nitrogen mustard, and topical carmustine (BCNU). Patients using topical treatment need follow-up every 2-3 months. [19]

Phototherapy with either broad- or narrow-band UV-B or PUVA can be effective in inducing remission. Phototherapy requires an evaluation to response after every 8-12 visits or monthly.

Large plaque parapsoriasis requires closer follow-up than small plaque parapsoriasis. Follow-up frequency is determined by the treatment modality used. Follow-up every 6 months is recommended. Increasing number of lesions, increase in lesion size, or the development of induration or epidermal atrophy should prompt a repeat skin biopsy to consider a diagnosis of MF in evolution. If patients remit or do not desire treatment, follow-up is still recommended to assess for recurrence or progression.

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Complications

Administration of topical chemotherapy agents may result in development of contact dermatitis.

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Consultations

Consult with a dermatologist specializing in cutaneous lymphoma to coordinate medical care if progression to MF (CTCL) occurs.

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