By Gary M. White, MD
Lesion on the inner thigh. Poikiloderma vasculare atrophicans on biopsy.
Large plaque parapsoriasis (LPP) is a premalignant condition that often progresses to cutaneous T-cell lymphoma (CTCL).
Red, scaly plaques, larger than 5 cm in diameter are typical (in contrast to small plaque parapsoriasis where the lesions are < 5 cm in diameter). The clinical triad of atrophy, telangiectasia, and hyper/hypopigmentation is called poikiloderma and may be seen here in a variant called poikiloderma vasculare atrophicans (PVA). PVA is not pathognomonic for LPP and may also be seen in other conditions, e.g., dermatomyositis and several genodermatoses. A retiform parapsoriasis occurs as well.
Any treatment for early stage CTCL is appropriate here. That would include topical steroids, UVB, nitrogen mustard (J Eur Acad Dermatol Venereol. 2013 Feb;27(2):163-8) and topical bexarotene.
The conversion rate to lymphoma has been estimated at about 10-35% per decade.
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