Small plaque parapsoriasis is a dermatological disease of unclear etiology, which is one of the forms of the so-called Broca’s disease. It is accompanied by the appearance of peeling plaques with a diameter of 2-5 centimeters of pink or bluish color on the surface of the skin of the trunk, upper and lower extremities. Diagnosis of small-plaque parapsoriasis is made on the basis of the results of skin examination, biopsy and histological examination of the tissues of pathological foci. Sometimes immunological studies are additionally used. Treatment of this dermatological disease is reduced to the elimination of provoking factors, improvement of microcirculation in the skin and correction of the immunological status of the patient. To solve these problems, both medications and physiotherapy procedures are used.
Small plaque parapsoriasis or benign plaque parapsoriasis is one of the types of dermatoses with a chronic course. It can be caused by various infectious, autoimmune and metabolic disorders in the body. The plaque form of parapsoriasis was described back in 1902 by dermatologist L. Brock. Years later, P. Samman divided Broca’s disease into two significantly different clinical forms – large and small-scale. Small-plaque parapsoriasis has a more benign course and a favorable prognosis, in extremely rare cases, pathology leads to the development of fungal mycosis. However, as with the large–plaque form, this condition develops against the background of various disorders in the body, including cancer – in such a situation, this disease acts as part of the paraneoplastic syndrome. That is why, in the presence of small-plaque parapsoriasis, in addition to eliminating skin manifestations, it is necessary to search for and treat the provoking disease.
The development of small-plaque parapsoriasis always occurs against the background of various pathological conditions affecting the human immune system. These can be foci of chronic infection (tonsillitis, carious teeth), worm infestation, various kinds of allergies and autoimmune conditions. Cases of rash development after taking certain medications are also described. It is assumed that as a result of constant stimulation of the immune system and a special type of reactivity of the body, a line is allocated among T-lymphocytes that can cause characteristic manifestations of small-plaque parapsoriasis. The above-mentioned immunocompetent cells have a reduced level of differentiation, which allows some researchers to consider this condition intermediate between an autoimmune and lymphoproliferative process.
A different point of view unites such conditions as large-plaque parapsoriasis, small-plaque parapsoriasis and malignant skin lymphoma. Adherents of this theory consider the plaque form of parapsoriasis to be the beginning of the development of lymphoma. At the same time, the small-plaque variant is an abortive form of this pathology, since it almost never leads to the development of lymphoma even with a long-term course. Very rarely, against the background of this dermatological condition, fungal mycosis can occur, so there is a theory that small-plaque parapsoriasis is the first manifestation of this malignant disease. Some dermatologists question this theory because of the benign course of the small-plaque form of Broca’s disease.
Small-plaque parapsoriasis occurs more often in men over the age of 30-40 years and often develops after an infectious disease or against the background of chronic pathology. Usually, the first rashes appear on the trunk in the epigastric region, then the rash elements spread to the lateral surfaces of the abdomen and chest, can affect the inner surfaces of the shoulders and thighs. Skin changes in small-plaque parapsoriasis are always located symmetrically relative to the median line of the body. At first, the rash has the character of pink spots, then the spots transform into plaques 2-6 centimeters in size, round or irregular in shape. The color of the plaques can change to brown and bluish-purple, in some cases this phenomenon is caused by incorrectly prescribed treatment of pathology.
In the future, skin peeling begins on the surface of rashes with small-scale parapsoriasis. Telangiectasia may occur, the skin becomes dry to the touch. Plaques almost never merge with each other, they are clearly separated from each other and from healthy areas of the skin. No subjective symptoms (skin itching, burning and others) are recorded in this condition. Plaques persist for a long time (from several months to several years) after which, under the influence of therapeutic measures or spontaneously, the resolution of rashes begins. Unlike the large-plaque form, after the disappearance of the manifestations of small-plaque parapsoriasis, there are no areas of atrophy or pigmentation disorders on the skin surface. In extremely rare cases, plaques begin to bother the patient with itching and burning – this may indicate the degeneration of this dermatological condition into a fungal mycosis.
The definition of small-plaque parapsoriasis is considered a rather complicated procedure in dermatology, since the clinical picture of this condition is quite nonspecific and resembles many other types of dermatoses. On examination, rounded clearly defined foci of pink, brown or bluish color on the abdomen, chest and limbs are revealed. The distribution of foci is symmetrical. Peeling and dryness of the skin is determined on the surface of the plaques, when questioned, it turns out that there are no subjective symptoms by the type of itching or burning. After the formation of the rash, it can remain unchanged for months or even years, which also serves as an indirect confirmation of small-plaque parapsoriasis.
The histological picture in small-plaque parapsoriasis indicates the presence of lymphohistiocytic infiltration in the dermis, mainly represented by T-lymphocytes. At the same time, there is also an increased number of neutrophils and mast cells, which indicates the presence of a weak inflammatory reaction or an allergic process. The blood vessels are dilated, the papillary layer of the dermis is edematous, fibroblast proliferation is noted. In the epidermis with small-plaque parapsoriasis, focal parakeratosis and acanthosis are detected, lymphocytes and pronounced edema can be detected in the thickness of the epidermis.
A feature of the development of small-plaque parapsoriasis is the fact that dermatological disorders are almost always provoked by another disease: inflammatory or tumor process, helminthic invasion, endocrine disorders. Therefore, an additional method of diagnosing a pathological condition is the study of the patient’s anamnesis or medical history – the specialist clarifies which pathologies the patient has suffered in the recent past, whether he is being treated now and for what reason. In the absence of indications of other diseases against the background of pronounced small-plaque parapsoriasis, a comprehensive examination of the body should be prescribed to detect malignant neoplasms, chronic inflammatory processes and worm lesions. Such studies are carried out by examining relevant specialists, studying classical laboratory blood and urine tests.
Treatment, prognosis and prevention
Therapy of small-plaque parapsoriasis is associated with a number of difficulties, primarily arising from the unclear etiology of this condition. Most dermatologists agree that in order to effectively eliminate a skin disease, it is necessary to identify and treat the provoking pathology. Therefore, patients with small-plaque parapsoriasis necessarily undergo oral cavity sanitation, elimination of chronic inflammation of the respiratory tract and ENT organs, deworming. Against the background of these therapeutic measures, the therapy of this dermatological condition will be much more effective.
For the treatment of small-plaque parapsoriasis, both complex and single-component vitamin preparations, antihistamines, as well as medications to improve microcirculation in the skin are used. Locally, corticosteroid ointments and drugs that stimulate regeneration processes can be prescribed. In some cases, physiotherapy procedures such as sunbathing, ultraviolet irradiation and PUVA therapy provide a good effect. The prospects for the treatment of small-plaque parapsoriasis are uncertain, certain therapeutic measures are not equally effective in different patients.
Due to the benign course of this form of plaque parapsoriasis, the prognosis for this disease is almost always favorable. Indications of its possible transformation into a fungal mycosis are considered by many experts to be a simple coincidence, rashes are almost always resolved over time without any traces. In many cases of small-plaque parapsoriasis, this occurs spontaneously a few months or years after the onset of the disease. Methods of prevention of this condition are insufficiently developed, timely treatment of infectious and inflammatory processes, worm infestations and other pathologies capable of provoking the development of small-plaque parapsoriasis is recommended.