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DIAGNOSIS:
MYCOSIS FUNGOIDES/LARGE
PLAQUE PARAPSORIASIS
• Psoriasiform pattern: often mimics chronic
spong derm or psoriasis, both clinically and
histologically
• Clues: look for epidermotropism, cytologic
atypia of lymphocytes, lining up of
lymphocytes along basal epidermis, and
What is your histologic diagnosis and what special Pautrier’s microabscesses (~30%)
studies should be done?
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CD2, CD3,
LARGE PLAQUE
CD4+ PARAPSORIASIS
• Somewhat controversial entity, now accepted as a
variant of MF
• Clinically, presents as large erythematous patches
and plaques
• Often progresses to poikilodermatous lesions
• Histology: mild psoriasiform hyperplasia with
spongiosis and few atypical lymphocytes
CD5, CD7, • Small plaque parapsoriasis (digitate dermatosis)
CD8- unrelated, and not considered variant of MF
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PSORIASIFORM DERMATITIS 1. PSORIASIS: Clinical
DIFFERENTIAL DIAGNOSIS: • Chronic dermatitis characterized by often
1. Psoriasis symmetric, erythemetous plaques with silvery scale,
variants include guttate and pustular psoriasis
2. Subacute/chronic spongiotic dermatitis
3. Lichen simplex chronicus (LSC) & prurigo
nodularis
4. Pityriasis rubra pilaris (PRP)
5. Syphilis (secondary)
6. Reiter’s syndrome
7. Mycosis fungoides/large plaque parapsoriasis
PSORIASIS: Histology
• Regular acanthosis, hypogranulosis, parakeratosis with
neutrophils
• Increased epidermal turnover (increased basal mits) and
tortuous papillary dermal capillaries
• Guttate, early and treated psoriasis exhibit less acanthosis
and may show significant spongiosis
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GUTTATE PSORIASIS EARLY OR TREATED PSORIASIS
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3. LICHEN SIMPLEX CHRONICUS 4. PITYRIASIS RUBRA PILARIS
(LSC) AND PRURIGO • Rare dermatosis, classic presentation with
NODULARIS erythroderma, hykeratotic patches and plaques with
• Hyperkeratosis, irregular acanthosis, hypergranulosis, follicular plugging
papillary dermal fibrosis and chronic inflammation
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6. REITER’S • Histology shows psoriasiform hyperplasia with
parakeratosis and numerous neutrophils, often
SYNDROME forming pustules
• Clinical: classic triad of • May be indistinguishable from pustular psoriasis
urethritis, uveitis and
arthritis, with
mucocutaneous lesions
• Crusted erythematous to
pustular papules and
plaques on feet, genitalia,
buttocks, and scalp