The conundrum of parapsoriasis versus patch stage of mycosis fungoides

Abstract

Terminological confusion with benign dermatosis, such as parapsoriasis en plaques, makes it difficult to diagnose mycosis fungoides in the early patch stage. Early diagnosis of mycosis fungoides (MF) is important for deciding on type of therapy, prognosis and for further follow-up. However, until recently, there has been no consensus on criteria that would help in diagnosing the disease early. Some believe that large plaque parapsoriasis (LPP) should be classified with early patch stage of MF and should be treated aggressively. However, there is no firm clinical or laboratory criteria to predict which LPP will progress to MF and we can only discuss about statistical probability. Moreover, long-term outcome analysis of even patch stage of MF is similar to that of control population. We therefore believe that LPP should be considered as a separate entity at least to prevent the patient from being given a frightening diagnosis. We also feel that patients need not be treated with aggressive therapy for LPP and will need only a close follow-up. This article emphasizes the criteria for diagnosing early MF and has highlighted the importance of considering LPP as a distinct benign entity.

A study of clinicopathologic profile of 15 cases of hypopigmented mycosis fungoides

“…[1] Also, the algorithm for diagnosis of classic presentations of early MF is not applicable for atypical clinical and histologic variants including hypopigmented MF, follicular and purpuric or palmoplantar MF. [2] Hence, the diagnosis of MF has to be reached based on clinical and histopathological correlation. Several studies have reported a latent period of 4-10 years from the onset of disease to definitive diagnosis.…”

Imatinib mesylate induced lichenoid drug eruption masquerading as small plaque parapsoriasis

“…2 Small plaque parapsoriasis is characterised by well circumscribed plaques of sizes two to six centimetres in diameter located on the trunk without atrophy or poikiloderma. 3 This case has been reported for the atypical presentation of lichenoid drug eruptions, masquerading as the lesions of small plaque parapsoriasis and also lichenoid drug eruption secondary to imatinib mesylate which is a rare entity.…”

Appearances in clinical dermatology

“…They may be 2 to 6 cm in diameter and rarely up to 20 cm in size, sometimes with a digitate or finger mark-like appearance (digitate dermatosis) and without atrophy or poikiloderma. [33] Dirty neck appearance Dirty neck appearance refers to reticulate pigmentation of the neck, seen in patients with atopic eczema. It involves the anterior or antero-lateral aspects of the neck It is often interpreted as an "accumulation of dirt" due to lack of proper washing of the neck region by the child [34] [ Figure 5].…”