Parapsoriasis en plaques large L41.4

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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extensive parapsoriasis; Large parapsoriasis en plaques; large plaque parapsoriasis; large spotted parapsoriasis; LPP; Parapsoriasis en grandes plaques Brocq; Parapsoriasis en plaques simples; Premalignant form of parapsoriasis en plaques

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Rare, androtropic, inflammatory, eminently chronic disease of the skin of unknown etiology. Large parapsoriasis en plaques, is considered to be the pre-mycoside phase (in situ stage) of Mycosis fungoides.

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Start in middle age (40-50 years).

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trunk; gluteal region, thighs, upper arms.

Clinical features
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Few (on average up to 6), more rarely also many (see fig.) inflammatory, not or only slightly elevated, larger (mostly >10 cm in diameter), round or oval, sometimes also by confluence bizarrely configured, sharply defined, pityriasiform reed, red, red-brown, also brown-yellow, sometimes moderately itching, sometimes symptomless patches or plaques, whose longitudinal axes are often aligned according to the cleavage lines. More rarely are ichthyosiform or "deck-chair-like", getigered aspects.

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Mostly little changed surface epithelium with plexus-like orthokeratosis. Dense lymphohistiocytic, focal epitheliotropic infiltrate in the upper dermis; possibly Pauterian microabscesses as in mycosis fungoides. In about 10-20% of the cases uncharacteristic eczematous picture.

General therapy
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The therapy of parapsoriasis en grandes plaques is purely symptomatic and not curative. Aggressive external as well as systemic therapy measures are contraindicated.

External therapy
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  • Careful phototherapy cycles with UV rays, especially UVB, and possibly also UVA1, should be observed during therapy breaks. Alternatively outpatient balneo-phototherapy with UVB or PUVA therapy (as systemic PUVA therapy or as PUVA bath therapy).
  • Dermatological climate therapy (maritime climate), which generally leads to a significant improvement.
  • Nursing external measures. Oily O/W lotions or saline or urea-containing creams and ointments(e.g. basodexan, nubral, calmuride).
  • In case of distinct itching creams or lotions containing glucocorticoids. Sparing use of cleaning agents such as syndets or soaps. Instead, use hydrophilic body oils as washing substitutes (e.g. ready-to-use preparations that are generally used as oil baths such as oil bath cordes, Balneum Hermal oil bath, Linola fat oil bath).

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Chronic course, increase in size of the herd. A transition to the stage infiltrativum of mycosis fungoides is to be expected in one third of the patients. No regression tendency.

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  1. Arai R et al (2012) Retrospective study of 24 patients with large or small plaque parapsoriasis treated with ultraviolet B therapy. J Dermatol 39:674-676
  2. Bordignon M et al (2009) The role of immunohistochemical analysis in the diagnosis of parapsoriasis. Acta Histochem 113:92-95
  3. Inaoki M et al (2010) Large plaque parapsoriasis with the "deck-chair" sign successfully treated with bath psoralen and ultraviolet A therapy. J Dermatol 37:570-572
  4. Kreuter A et al (2008) High association of human herpesvirus 8 in large-plaque parapsoriasis and mycosis fungoides. Arch Dermatol 144:1011-1016
  5. Nag F et al (2013) Ichthyosiform large plaque parapsoriasis: report of a rare entity. Indian J Dermatol 58:385-387


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Last updated on: 29.10.2020