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T cell nature of exocytic and dermal lymphoid cells in atrophic parapsoriasis demonstrated by monoclonal Leu 1 and affinity isolated antibodies.

Tissues from atrophic large plaque parapsoriasis were examined using the indirect immunoperoxidase technique with a monoclonal T cell antibody as primary antibody, and affinity isolated peroxidase conjugated goat anti-mouse IgG as second stage antibody. The "T" cell nature of the dermal infiltrate and of single exocytic epidermal lymphocytes was demonstrated. The results obtained suggest that the method utilized will be useful for the demonstration of lymphoid cell subpopulations in a variety of cutaneous disorders in which a lymphocytic infiltrate forms a significant component of the histopathology observed. This technique also has the potential of providing information on the topographic localization and differentiation of lymphocytes within the various levels of the skin. Certain technical manipulations which may result in an improvement in the quality of results obtained are also discussed.

Antibodies, Monoclonal↗

Demonstration of frequent occurrence of clonal T cells in the peripheral blood but not in the skin of patients with small plaque parapsoriasis.

Clinical, immunohistological, and molecular biological data suggest the chronic dermatosis small plaque parapsoriasis (SPP) to be a precursor of mycosis fungoides (MF). However, most data are contradictory and confusing due to inexact definition of SPP. Recently, clonal T cells were detected in skin and blood samples of early MF. Because demonstration of identical T-cell clones in skin and blood of SPP patients would indicate a close relationship of SPP to MF, we investigated the clonality of skin and blood specimens from 14 well-defined SPP patients. By a polymerase chain reaction (PCR) amplifying T-cell receptor gamma rearrangements and subsequent high-resolution electrophoresis, clonal T cells were detected in 9 of 14 initial and 32 of 49 follow-up blood samples, but in 0 of 14 initial skin specimens. Even a clone-specific PCR showing the persistence of the initial blood T-cell clone in 20 of 20 follow-up samples, failed to detect the T-cell clone in the skin. In 2 patients, the clonal T cells were shown to be CD4(+). For the first time, the majority of SPP patients was shown to carry a T-cell clone in the peripheral blood. Although a relation between circulating clonal T cells and SPP cannot directly be proven by the applied techniques, our results indicate blood T-cell clonality to be a characteristic feature of SPP and CTCL because analysis of multiple controls and clinical workup of our SPP patients excluded other factors simulating or causing a clonal T-cell proliferation. A sufficient cutaneous antitumor response but also an extracutaneous origin of the T-cell clones might explain the failure to detect skin infiltrating clonal T cells.

Aged↗

Expression of HECA-452 in parapsoriasis and mycosis fungoides.

We have investigated the HECA-452 expression in large plaque parapsoriasis (PP) and mycosis fungoides (MF) patients, evaluating the potential role of this biomarker in both cutaneous disorders. Skin specimens from 72 PP and 61 MF patients were selected in this study. We compared their actual histological diagnosis with their previous diagnosis and we found that all 72 PP patients had the same diagnosis as before (stable PP), while 26 out of 61 MF had a previous PP histological diagnosis (evolving PP). Our results show an increased expression of HECA-452 in MF compared to PP (p<0.01). Furthermore, evolving PP showed a significantly higher level of HECA-452 than stable PP (p<0.05). We conclude that HECA-452 expression increases during the natural history of Mycosis Fungoides. HECA-452 could be used as a biomarker for MF and predict which PP evolves to MF.

Antibodies, Monoclonal↗

[Acute parapsoriasis in a 5-year-old girl].

A case is reported of rarely observed skin changes in a girl aged 5 years. The changes resembled those observed in acute parapsoriasis (p. lichenoides et varioliformis of Mucha-Habermann). The diagnosis was established after finding characteristic polymorphic lesions in the form of papulae, necrotizing vesicles, ulcerations, desquamation of certain papulae typical of p. guttata, long-term persistence of the lesions and good general condition of the child. The lesions were situated on the trunk, and in a lower degree on the face and extremities. Before the disease the girl hand contact with insecticides (Ovadofox) and detergents.

Acute Disease↗

Poikilodermatous mycosis fungoides and atrophic large-plaque parapsoriasis exhibit similar abnormalities of T-cell antigen expression.

We studied the immunohistologic findings of skin biopsy specimens from 21 patients with poikiloderma (14 with mycosis fungoides [MF] and seven with atrophic large-plaque parapsoriasis [ALPP]). Both types of poikiloderma were similar with regard to T-cell antigen expression. In each case, most T cells expressed the CD4+ (helper/inducer) phenotype and lacked Leu-8 antigen. T cells were also deficient in Leu-9 antigen in most cases (MF, 11/14 [79%]; ALPP, 4/7 [57%]). These T-cell antigen deficiencies are similar to those described previously in various types of MF and indicate that such deficiencies are common in minimally infiltrated, patch-stage MF lesions. Because combined Leu-8/Leu-9 antigen deficiencies are uncommon in inflammatory skin diseases, our findings are consistent with the view that ALPP is an early form of MF, as had been suggested previously by results of clinicopathologic studies.

Adult↗

[The parapsoriasis-group].

This review deals with the clinical and histological criteria of the parasporiasis-group. The advantage of a simplified classification based on clinical differences is demonstrated. Furthermore the proportion of cases is shown in which malignant transformation (non-Hodgin-Lymphomas) has been reported. Finally it is referred to careful monitoring of patients with distinct parapsoriasis-diseases.

Diagnosis, Differential↗

Parapsoriasis.

Parapsoriasis is a term which encompasses a number of differing pathologic states clinically manifesting chronic recalcitrant erythematous scaling lesions. Although these various diseases have some similar clinical and histopathological features, they are obviously quite different from the standpoint of malignant potential and prognosis. The classification suggested herein has been developed in an attempt to resolve the existing confusion and to offer a simplified approach to the study of a complex problem.

Acute Disease↗

Treatment of parapsoriasis en plaques, mycosis fungoides, and Sézary's syndrome with trioxsalen baths followed by ultraviolet light.

Three patients with parapsoriasis en plaques (PEP), fifteen with mycosis fungoides (MF), and one with Sézary's syndrome (SS) were given a bath to which a small amount of trioxsalen solution had been added, and then exposed to ultraviolet (UV) radiation from a bank of dysprosium lamps. Within 2--6 months of this treatment the skin lesions healed completely or almost completely in all 3 patients with PEP, in all 7 with MF stage II and in 4 of 5 with MF stage III. Two patients with MF stages IV--V showed a fair degree of improvement. One with erythrodermic form of MF responded, but poorly. The patient with SS and the one with erythrodermic MF responded with severe phototoxic reactions.

Adult↗

Balneophototherapy in small plaque parapsoriasis--four case reports.

Four patients suffering from small plaque parapsoriasis were treated successfully with balneophototherapy. Within 4 weeks salt-water baths and UV irradiation resulted in clinical clearing of more than 90% of lesions with a duration of total clinical response between 8 and 12 weeks without further maintenance treatment.

Adult↗