By Gary M. White, MD
Small plaque parapsoriasis is a term used to describe a benign, but often chronic condition characterized by red, scaly patches and plaques. The term chronic superficial scaly dermatitis is also used. As a general trend, small plaque parapsoriasis is benign, whereas large plaque parapsoriasis may eventuate into cutaneous T-cell lymphoma.
Individual lesions are red, scaly, and round or oval. Digitate (in the shape of a digit) lesions may occur. Classically, the lesions are less than 5 cm in diameter, as opposed to large plaque parapsoriasis. The exception is digitate dermatosis where the length of the lesion may be significantly longer than 5 cm. The surface is often slightly wrinkled and may appear like cigarette paper. The trunk is most commonly affected and the distribution is symmetric. Often there are no symptoms although mild itching may occur. The course is often chronic, lasting years.
Despite the thought that this condition is usually benign, histologic examination should be performed initially and routinely (e.g., yearly during the first few years). Topical steroids (e.g., triamcinolone) may have some benefit. Narrowband UVB has been shown helpful [AD 1999;135;1377]. Some patients may not require treatment, or just the use of a bland emollient.
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