Parapsoriasis - Causes, Symptoms, Diagnosis, and Treatment

Introduction

Parapsoriasis is a group of inflammatory skin disorders that appears like psoriasis. Parapsoriasis is a rare cutaneous condition, and it is commonly observed in middle-aged people. Parapsoriasis is more susceptible in males in comparison with females. Parapsoriasis is an inflammatory condition, and scaly patches with a pink hue characterize the lesion. Parapsoriasis has a chronic course, and sometimes it is resistant to treatment. The exact cause of the progression of parapsoriasis is unknown. The clinical presentation of parapsoriasis varies from one person to another person.

What Is Parapsoriasis?

Parapsoriasis is a rare inflammatory cutaneous lymphoproliferative dermal disorder commonly affecting people in their middle age. It is observed that males are affected more by parapsoriasis than females. Parapsoriasis is a skin inflammatory condition characterized by pink-colored scaly patches. The scaly plaque's size may vary from 1 cm to 5 cm.

Parapsoriasis is classified into two types, small plaque parapsoriasis, and large plaque parapsoriasis. Proper clinical examination and histopathological findings are essential for diagnosing parapsoriasis. It is also observed that the non-sun-exposed areas of the body are commonly affected with parapsoriasis.

What Are the Causes of Parapsoriasis?

The exact cause of the occurrence of parapsoriasis is not known. It is found that parapsoriasis is a lymphoproliferative disorder. Small plaque parapsoriasis is a chronic benign condition. In contrast, large plaque parapsoriasis is a premalignant condition that may lead to severe malignant diseases such as mycosis fungoides and cutaneous T-cell lymphoma.

Some of the triggers of psoriasis are mentioned below.

• Psychological stress.

• Smoking.

• Alcohol consumption.

• Skin injury.

• Allergic reactions to medications.

• Infections.

• Poor diet.

What Are the Symptoms of Parapsoriasis?

The scaly plaques that appear in the parapsoriasis are wrinkled, and it is very thin. The small plaque parapsoriasis is pink or yellowish-brown in color and seems with scaly patches. The shape of the scaly patches seen in small plaque parapsoriasis is oval or round. Small plaque parapsoriasis is commonly observed in the upper extremities, lower extremities, and abdomen. Sometimes small plaque parapsoriasis is asymptomatic.

The distribution of plaques resembles digits or fingers; hence the small plaque parapsoriasis is also known as digitate dermatosis. Large plaques characterize large plaque parapsoriasis, and the shape of scaly plaques in large plaque parapsoriasis is irregular. Symptoms of large plaque parapsoriasis are primarily present in the body's non-sun-exposed or limited sun-exposure parts. The common site for large plaque parapsoriasis is the breasts, thighs, buttocks region, and the lower part of the abdomen. Large plaque parapsoriasis is a premalignant condition and sometimes progresses to cancer.

The symptoms of parapsoriasis are mentioned below.

• Thin scaly patches in pink or yellow to brown.

• Oval or round-shaped patches.

• The size of the patch ranges from 2 cm to 5 cm.

• Commonly affecting areas are breasts, buttocks, thighs, and abdomen.

• The distribution of patches resembles digits or fingers, called digitate dermatosis.

• Dusky red irregular patches are observed in large plaque parapsoriasis.

• The size of the plaques is 6 cm.

How to Diagnose Parapsoriasis?

Clinical examination and skin biopsy help in the diagnosis of parapsoriasis. The clinical presentation of parapsoriasis includes pink scaly patches in the case of small plaque parapsoriasis and irregular in large plaque parapsoriasis. Symptoms are evaluated in non-sun-exposed regions, including the upper and lower extremities. The skin biopsy is made from the affected region, and the histopathological findings include spongiosis, parakeratosis, and inflammatory infiltration.

The diagnostic features for the diagnosis of parapsoriasis are mentioned below.

• Clinical examination.

• Skin biopsy or punch biopsy in particular.

• Histopathological findings include parakeratosis, mild spongiosis, atrophic changes, and lymphocytic infiltration.

What Is the Treatment of Parapsoriasis?

Parapsoriasis is sometimes asymptomatic and requires treatment to avoid the risk of cancer. Topical corticosteroids can be applied in the moderate form of small plaque parapsoriasis. In severe cases, phototherapy, in addition to steroidal therapy, is advised. Phototherapy is recommended two to three times a week. Anti-inflammatory and immunosuppressive action is provided by phototherapy. Psoralen and ultraviolet A or PUVA, Ultraviolet A, and ultraviolet B or UVB are used in phototherapy to examine the disease. Skin moisturizers such as emollients can also be used to maintain skin moisture.

The treatment measures for parapsoriasis are mentioned below.

• Topical corticosteroids.

• Phototherapy includes psoralen and ultraviolet ray A or PUVA, ultraviolet B, or UVB.

• Applications of emollients, including lotions, petroleum jelly products, and other skin moisturizers, can reduce parapsoriasis discomfort.

• Complementary therapies include acupressure, acupuncture, massage, reiki, and yoga.

What Is the Differential Diagnosis of Parapsoriasis?

Parapsoriais has various clinical presentations, and the symptoms of parapsoriasis are similar to other dermal disorders. The distinguishing features are well-diagnosed to avoid misdiagnosing parapsoriasis from other skin disorders.

The differential diagnosis of parapsoriasis is listed below.

• Allergic contact dermatitis.

• Psoriasis.

• Guttate psoriasis.

• Nummular dermatitis.

• Nummular eczema.

• Pityriasis alba.

• Mycosis fungoides.

• Cutaneous T cell lymphoma.

• Pityriasis lichenoides.

• Syphilis.

• Pityriasis rosea.

• Erythroderma.

• Dermatomyositis.

• Kawasaki disease, the onset of pityriasis rubra pilaris in children.

• Seborrheic dermatitis.

• Erythrokeratodermia variabilities.

What Are the Natural Home Remedies for Psoriasis?

Symptoms of dermal disorders, including psoriasis and parapsoriasis, are resolved and reduced with some natural remedies. Monitoring the signs is also important to avoid the allergic host response with natural remedies.

The natural remedies to improve the symptoms of parapsoriasis are listed below.

• Sun exposure.

• Capsaicin, a component of red pepper, contains an anti-inflammatory effect.

• Probiotics in fermented foods.

• Curcumin is an active ingredient in turmeric.

• Oregon grape, a herbal remedy.

• Aloe vera has an anti-inflammatory effect.

• Apple cider vinegar.

• Tea tree oil contains anti-inflammatory, antifungal, and antibacterial effects.

• Moisturizers.

• Salt water bath.

• Oatmeal bath.

• Wet dressings.

• Regular exercises.

• Proper healthy diet.

• Drink plenty of water and stay hydrated.

• Consumption of omega 3-rich fatty acids.

Conclusion

Parapsoriasis is a rare inflammatory and lymphoproliferative dermal disorder which often resembles psoriasis. The clinical features of parapsoriasis are the raised scaly patches on the breasts, buttocks, thighs, and upper and lower extremities. Small plaque parapsoriasis is called digitate dermatosis because of plaque distribution like digits or fingers. Sometimes parapsoriasis is asymptomatic, and large plaque parapsoriasis is a premalignant condition requiring treatment to avoid cancer risk. Phototherapy is the best treatment option for parapsoriasis. The doctor recommended steroid therapy in addition to phototherapy in severe forms of parapsoriasis. Early diagnosis and doctor-advised treatment will prevent the incidence of parapsoriasis and the risk of cancer.