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Derm diagnosis.

Sherry Boschert

A 50-year-old man presented with a 15-year history of this strikingly linear, slightly scaly, pruritic rash. A Vietnam veteran, the patient was convinced the rash was due to Agent. Orange exposure.

What's your diagnosis?

BRECKENRIDGE COLO. -- Retiform parapsoriasis, or parapsoriasis variegata, is a rare variant of large plaque parapsoriasis that typically presents with a zebralike pattern of atrophic plaques; Dr. Anali Bowen said at a seminar on clinical dermatology sponsored by Bristol-Myers Squibb Co.

In this patient, the biopsy showed a mildly akeratotic epidermis and some mounded areas of parakeratosis alternating with orthokeratosis. There was lymphocytic infiltrate. Polymerase chain reaction testing showed that he did have a T-cell receptor gene rearrangement, but his lymphocytes were normal; so there was no evidence of cutaneous T-cell lymphoma.

CT scans of his chest, abdomen, and pelvis were normal, as were his laboratory results.

Retiform parapsoriasis is quite often malignant; said Dr. Bowen of the University of Utah, Salt Lake City. In fact, 6f all the related lymphoproliferative diseases, retiform parapsoriasis may be the most malignant.

For example, small plaque psoriasis is almost never malignant. Lymphomatoid papulosis turns out to be malignant in 10%-20% of cases. Likewise, large plaque parapsoriasis overall is malignant in 10%-20% of cases.

Retiform parapsoriasis, however, progresses "to cutaneous T-cell lymphoma in almost 100% of cases.

There continues to be controversy over whether large plaque parapsoriasis might actually be mycosis fungoides, he noted.

"This is a bad actor," Dr. Bowen said.

Because of this prognosis, the patient was treated with PUVA three times a week and with interferon-[alpha].

He was lost to. follow-up, when he moved shortly after beginning treatment.

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Author:Kirn, Timothy F.
Publication:Family Practice News
Article Type:Brief Article
Geographic Code:1USA
Date:Jan 1, 2002
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