Parapsoriasis en plaques benign small foci L41.3

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Benign small parapsoriasis en plaques; Brocq's disease in the narrower sense; Chronic superficial dermatitis; Digitate dermatosis; digitiform parapsoriasis; Parapsoriasis en petites plaques; Parapsoriasis en Plaques small focal type; Retiform parapsoriasis; Small plaque parapsoriasis

Definition
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Chronic, idiopathic, small-spotted dermatitis along the cleavage lines of the skin whose nosological position is not yet definitively established. There is no relationship to psoriasis. The relationship to non-tolent T-cell lymphomas is not established. S.a.u. Parapsoriasis en plaques.

Etiopathogenesis
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Unknown. The cutaneous infiltrate consists mainly of CD4+ lymphocytes. In some cases a T-cell clonality has been detected. In these cases the risk of progression into T-cell lymphoma is about 20% over a 5-year period. Familial occurrence is described.

Manifestation
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Occurs in adults between 30 and 75 (medium 50 years) years of age, rarely in childhood. Preferred in men. m:w=5:1; no preference of certain ethnic groups.

Localization
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Mainly lateral parts of the trunk; furthermore extremities and face. Palmae and Plantae are always free. Capillitium and mucous membrane regions as well.

Clinical features
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Numerous (usually more than 20), predominantly the size of 2.0-5.0 cm not exceeding, yellow-red or also light yellow, oval or roundish, often however finger-shaped stretched spots (tiger pattern) or also easily infiltrated (hardly eleviated), mostly blurred plaques. Finger-shaped "patches" can also exceed the "5 cm limit" on the trunk and grow out to 10-12 cm. Only slight, hardly visible, lesional desquamation.

Formation of larger plaques (patches) by confluence.

Apparent coarsening of the skin field due to very fine distortions of the horny layer; this is the picture of pseudoatrophy of the skin: cigarette-paper-like foldable skin without signs of atrophy in the histological substrate.

In rare cases, a "psoriasis-like" aspect with nummular, clearly increased consistency and eliminated plaques appears.

Histology
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Superficial, interstitial lymphocytic (predominantly CD4+ cells) dermatitis with discrete acanthosis, mocking, mostly low spongiosis, only focal, discrete epidermotropia without parakeratosis.

Differential diagnosis
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Therapy
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  • Phototherapy or balneo-phototherapy with UVA1 or UVB rays.
  • Alternatively PUVA therapy (PUVA should be used with caution because of possible permanent damage).
  • Dermatological climate therapy (maritime climate), which generally leads to a significant improvement.
  • For UV-resistant foci, experiment with external steroids (e.g. Ecural fat cream). Otherwise, external skin care measures such as greasing lotions (e.g. Lipoderm Lipolotio) or salt-containing creams R146 or urea-containing creams and ointments.
  • Economical use of cleaning agents such as syndets or soaps.
  • Instead, use of hydrophilic body oils as washing substitutes, which are generally used as oil baths (e.g. oil bath Cordes, Linola Fett N oil bath, Balneum Hermal oil bath).
  • Alternatively, oil/surfactant combinations are also possible (e.g. Eucerin shower oil).

Progression/forecast
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Benign, eminently chronic course, marked improvement under sun or UV irradiation. In the summer months the skin changes can disappear completely under the influence of the sun. However, they recur regularly during the dark season. Rarely healing.

Note(s)
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Some studies doubt the absolute "benignity" of this small-focus form of parapsoriasis, which has so far been seen contrapuntally to the malignant large-focus variant (precursor of mycosis fungoides). In larger collectives the transition to a relevant T-cell lymphoma is given with 1:30 (Belousova IE et al. 2008)

Literature
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  1. Aydogan K et al (2006) Narrowband UVB phototherapy for small plaque parapsoriasis. J Eur Acad Dermatol Venereol. 20: 573-577
  2. Baderca Fet al. (2014) Biopsying parapsoriasis: quo vadis? Are morphological stains enough or are ancillary tests needed? Rome J Morphol Embryol 55(3 Suppl):1085-1092
  3. Belousova IE et al (2008) A patient with clinicopathologic features of small plaque parapsoriasis presenting later with
  4. plaque-stage mycosis fungoides: report of a case and comparative retrospective study of 27 cases of "nonprogressive" small plaque parapsoriasis. J Am Acad Dermatol 59:474-482
  5. Hofer A et al (1999) Narrowband (311-nm) UV-B therapy for small plaque parapsoriasis and early-stage mycosis fungoides. Arch Dermatol 135: 1377-1380
  6. Holubar K (2003) Psoriasis and parapsoriasis: since 200 and 100 years, respectively. J Eur Acad Dermatol Venereol 17: 126-127
  7. Matthes U et al (1990) Hereditary parapsoriasis en petites plaques and psoriasis vulgaris in one family. Act Dermatol 16: 110-111
  8. Siddiqui J et al (1997) Clonal dermatitis: a potential precursor of CTCL with varied clinical manifestations. J Invest Dermatol 108: 584
  9. Väkkevä I et al (2005) A retrospective study of the probability of the evolution of parapsoriasis into mycosis fungoides. Acta Derm Venereol 85: 318-323
  10. Tartaglia F et al (2007) Retroperitoneal liposarcoma associated with small plaque parapsoriasis. World J Surg Oncol 5:76

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Last updated on: 29.10.2020