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Parapsoriasis en plaques largeL41.4

Author:Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

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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DefinitionThis section has been translated automatically.

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.

Occurrence/EpidemiologyThis section has been translated automatically.

m:w=3:1

ManifestationThis section has been translated automatically.

Start in middle age (40-50 years).

LocalizationThis section has been translated automatically.

trunk; gluteal region, thighs, upper arms.

Clinical featuresThis section has been translated automatically.

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.

HistologyThis section has been translated automatically.

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 therapyThis section has been translated automatically.

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

External therapyThis section has been translated automatically.

  • 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).

Progression/forecastThis section has been translated automatically.

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.

LiteratureThis section has been translated automatically.

  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

Authors

Last updated on: 29.10.2020

Author: Prof. Dr. med. Peter Altmeyer