Parapsoriasis

Question 1

What decade of life does SPP peak?

Answer 1

5th

Question 2

sex predominance?

Answer 2

male

Question 3

what can be seen in superficial dermis? Of small plaque

Answer 3

sparse lymphoid infiltrates of CD4 with T cell clonality

Question 4

histology of small plaque parapsoriasis ?

Answer 4

mild nonspecific spongiotic dermatitis with focal parakeratosis

Question 5

-clinical feature of small plaque parapsoriasis ?

Answer 5

Patches with fine scales (טלאים עם קשקש עדין)

Question 6

patches description?

Answer 6

round to oval, <5 cm, slightly erythematous, fine scale, yellow hue

Question 7

most typical distinct presentation of small plaque parapsoriasis?

Answer 7

digitate dermatosis”-elongated finger like symmetrical patches on flanks, 10 cm or more

Question 8

nature of disease of small plaque parapsoriasis ?

Answer 8

chronic, generally asymptomatic or pruritic

Question 9

course of disease?

Answer 9

early- wax and wane. Late- persist and progress to be extensive

Question 10

distribution of small plaque parapsoriasis ?

Answer 10

widespread or limited

Question 11

what is special about the limited form of SPP?

Answer 11

sun protected areas

Question 12

progression to MF? ( SPP)

Answer 12

very rare

Question 13

how is SPP different with pityriasis rosea?

Answer 13

herald patch, spontaneous resolution within few months

Question 14

treatment of SPP?

Answer 14

can be only followed, also topical CS and NBUVB

Question 15

does LARGE PLAQUE PARAPSORIASIS have a risk to progress to MF?

Answer 15

yes, high risk

Question 16

clinical features of large

Answer 16

erythematous patches on sun protected areas

Question 17

how do you treat large plaque parapsoriasis?

Answer 17

• same as early MF

Question 18

PITYRIASIS LICHENOIDES - population prevalence?

Answer 18

more in pediatric

Question 19

pitreyasis lichenoides and sex ? is it common more among males or females?

Answer 19

male predominance

Question 20

with what is lichenoides associated with?

Answer 20

infections and drugs

Question 21

infections associated with PLEVA?

Answer 21

• viral (VZV, HIV, EBV,PVB19)

Question 22

drugs associated with PLEVA?

Answer 22

estrogen-progesteron, infliximab, adalimumab, statins

Question 23

what can explain the association of PL with lymphoproliferative disorders such MF?

Answer 23

T cell clonality and presence of CD 30 cells in some variants

Question 24

what important evaluation do patients with PL and aberrant T cell phenotype have to undergo?

Answer 24

clinicopathological correlation, molecular studies of T cell clonality

Question 25

clinical features? pitryasis lichenoides

Answer 25

recurrent crops of spontaneously regressing erythematous to purpuric papules

Question 26

what is the course of PLC (PITYRIAIS LICHINOIDES CHRONICA) and the status post?

Answer 26

indolent course, regressing over weeks to months. May leave hypopigmented macules

Question 27

what may be the presenting complaint in dark skin patients with PLC?

Answer 27

hypopigmented macules

Question 28

what lesions we see in PLEVA and what is the course?

Answer 28

asymptomatic crusts, ulcers, occasionally vesicles or papules, resolve within weeks

Question 29

in what way do they heal if dermal damage is extensive?

Answer 29

varioliform scars

Question 30

is PL usually systemic or confined to skin?

Answer 30

confined to skin

Question 31

what is febrile ulceronecrotic mucha haberman disease?

Answer 31

severe variant of PLEVA where large confluent necrotic lesions with mucosal, gastro, pulmonary involvement

Question 32

what is important in predicting outcome of disease?

Answer 32

distribution of skin lesions

Question 33

what is the usual course in children?

Answer 33

more persistent and widespread distribution

Question 33

what is the relationship btw the course of disease and distribution?

Answer 33

shorter with diffuse distribution and longer with peripheral distribution

Question 33

- what is the histology in an acute lesion? of PL

Answer 33

dense wedge shaped lymphocytic infiltrate in adnexal epithelia (eccrine,follicular) Epidermal parakeratosis , erythrocyte extravasation

Question 34

what is the pathology of PL?

Answer 34

perivascular interface dermatitis

Question 34

DD for PLC?

Answer 34

guttate psoriasis, LP, PR, 2nd syphilis, drug eruptions, lymphomatoid papulosis

Question 34

what is the histology in a chronic lesion? of PL

Answer 34

parakeratosis, mild infiltrate, keratinocyte necrosis

Question 35

DD for PLC?

Answer 35

-A- guttate psoriasis, LP, PR, 2nd syphilis, drug eruptions, lymphomatoid papulosis.

Question 36

WHAT IS THE THE DIFFERENTIAL FOR SMALL PLAQUE PARAPSORIASIS?

Answer 36

Pityriasis rosea Drug eruption, in particular pityriasis rosea-like Pityriasis lichenoides chronica Psoriasis, including guttate Mycosis fungoides Secondary syphilis Nummular dermatitis

Question 37

WHAT ARE THE TREATMENT FOR SMALL PLAQUE PARAPSORIASIS ?

Answer 37

Therapeutic approaches are based primarily on uncontrolled case series, case reports, or anecdotal evidence. Need to reassure them that the risk for MF is low. Patients may be followed without treatment if they prefer. other options include: topical corticosteroids and NBUVB (but reoccurrence is high). Patients may be followed without treatment if they prefer.

Question 38

what is pitryasis lichenoides ?

Answer 38

uncommon disorder that encompasses: -pityriasis lichenoides et varioliformis acuta (PLEVA) - the febrile ulceronecrotic Mucha–Habermann disease (FUMHD) variant of PLEVA - pityriasis lichenoides chronica (PLC). These acute and chronic forms of pityriasis lichenoides exist on a disease spectrum with variable presentations that can pose diagnostic and therapeutic challenges. They are papular, often clonal T cell disorders that may rarely be associated with MF.

Question 39

which population is affected most by pitryasis lichenoides?

Answer 39

is more prevalent in the pediatric population, it affects patients in all age groups, races, and geographic regions. There is a male predominance.

Question 40

what is the pathogenesis of Pitryasis lichenoides?

Answer 40

Pathogenesis is unkown. There is some evidence to support PLEVA being associated with viral infections, especially varicella–zoster virus, HIV, parvovirus B19, and Epstein–Barr virus. Additional reports have described its association with medications (e.g. estrogen–progesterone, infliximab, adalimumab, statins), radiocontrast dye, and vaccines

Question 41

what are the clinical features of pitryasis lichenoides? talk about PLEVA and its manifestation

Answer 41

Pityriasis lichenoides presents as recurrent crops of spontaneously regressing erythematous to purpuric papules . The acute form (PLEVA) and the chronic form (PLC) exist on a disease continuum. But Many patients have intermediate or mixed manifestations, In patients with PLEVA: individual lesions develop crusts, ulcers, and occasionally vesicles or pustules, which may heal with ­varioliform scars if dermal damage is extensive. Lesions are usually asymptomatic and typically resolve within weeks. Disease manifestations are confined to the skin.... except rarely, when acute lesions are associated with malaise, fever, lymphadenopathy, arthritis, and/or bacteremia. The term febrile ulceronecrotic Mucha–Habermann disease (FUMHD) has been used to refer to such severe variants in which large, confluent necrotic skin lesions as well as mucosal, gastrointestinal, and pulmonary involvement can be observed. In the latter group, an associated mortality rate of up to 15% has been reported

Question 42

what about PLC and its clinical manifestation?

Answer 42

In PLC, the papules are erythematous to red–brown and scaly. They pursue a more indolent course, regressing over weeks to months. When these lesions subside, there may be residual hypo­pigmented macules; the latter are more obvious in individuals with darker skin phototypes and may be the presenting complaint.

Question 43

How is the course of Pitryasis lichenoides?

Answer 43

Pityriasis lichenoides can resolve spontaneously after weeks to months or it may pursue a chronic relapsing course, sometimes interspersed with long periods of remission. חשיבות הפיזור !!! Some studies have suggested that the distribution of skin lesions is more important than their acute or chronic nature in predicting outcome *diffuse distribution - shorter course * peripheral distribution - longest clinical course. in children its a bit different : more persistent course and widespread distribution of lesions :(