Parapsoriasis en plaques large L41.4

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.

m:w=3:1

Start in middle age (40-50 years).

trunk; gluteal region, thighs, upper arms.

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.

• 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).

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