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Indian Journal of Dermatology
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Table of Contents 
CORRESPONDENCE
Year : 2021  |  Volume : 66  |  Issue : 1  |  Page : 96-98
Histopathologic evaluation of parapsoriasis from the perspective of NB-UVB/PUVA therapy on the outcome and recurrence of the disease


1 Department of Pathology, School of Medicine, Mustafa Kemal University, Serinyol-Hatay, Turkey
2 Department of Dermatology, School of Medicine, Mustafa Kemal University, Serinyol-Hatay, Turkey

Date of Web Publication1-Feb-2021

Correspondence Address:
Tumay Ozgur
Department of Pathology, School of Medicine, Mustafa Kemal University, Serinyol-Hatay
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.IJD_654_18

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How to cite this article:
Ozgur T, Serarslan G, Doğan E. Histopathologic evaluation of parapsoriasis from the perspective of NB-UVB/PUVA therapy on the outcome and recurrence of the disease. Indian J Dermatol 2021;66:96-8

How to cite this URL:
Ozgur T, Serarslan G, Doğan E. Histopathologic evaluation of parapsoriasis from the perspective of NB-UVB/PUVA therapy on the outcome and recurrence of the disease. Indian J Dermatol [serial online] 2021 [cited 2021 Mar 3];66:96-8. Available from: https://www.e-ijd.org/text.asp?2021/66/1/96/308508




Sir,

Parapsoriasis, presented as an early stage of cutaneous T-cell lymphoma, is mostly treated with psoralen and ultraviolet A (PUVA) therapy and narrowband ultraviolet B (NB-UVB) phototherapy.[1],[2] In the present study, our aim was to document the histopathologic findings before and after NB-UVB/PUVA treatment and to compare these findings with the existence of disease recurrence and clinical subtypes.

The archived files of small plaque parapsoriasis (SPP) and large plaque parapsoriasis (LPP) patients with control biopsies taken between 2008–2017 at the dermatology clinic in Mustafa Kemal University, were reviewed and 53 patients were selected. Biopsies of these patients treated with NB-UVB/PUVA were evaluated histopathologically before and after treatment. The architecture of the epidermis, the presence of epidermotropism and interface dermatitis, the type of dermal infiltrate and its distributions, were examined. The histopathologic parameters were evaluated semiquantitatively.[3],[4] Around 37 patients had been available for recurrence data collection through clinical follow-up, and the rest were off the record. The statistical analyses were performed using Pearson's Chi-square, Wilcoxon signed-rank, and Mann Whitney-U tests.

There were 40 (75.5%) SPP and 13 (24.5%) LPP patients [Figure 1] and [Figure 2]. The patients' mean age was 50.91 ± 13.33. Of the 53 patients, 38 (71.6%) were male and 15 (28.4%) were female. While 16 (30.2%) patients had recurrence, 37 (69.8%) patients remained disease-free. Epidermotropism was found in all cases and single lymphocyte epidermotropism was the most prominent finding before treatment (45%) [Figure 3]. Epidermal changes seemed to be the most common finding before treatment. While 10 (18.9%) cases had no epidermal damage, 20 (37.7%) cases presented with psoriasiform hyperplasia and 23 (40.5%) cases had irregular hyperplasia. Moreover, parakeratosis was observed in 17 (32.1%) cases and epidermal findings were diminished in 40 (75.5%) cases after treatment. There were dermal changes in all cases after treatment [Figure 4], fibrosis and melanophage infiltration were statistically significant (P < 0.001 in both). The distribution of histopathologic parameters before and after treatment was statistically similar among patient biopsies with and without recurrence including clinical subtypes (P > 0.05) [Table 1].
Figure 1: Small plaque parapsoriasis lesion in a patient

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Figure 2: Large plaque parapsoriasis represented clinically

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Figure 3: Single/haloed atypical lymphocytes in epidermis with superficial dermal infiltration before treatment (× 20, H&E)

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Figure 4: Vacuolar degeneration in basal layer of epidermis, melanophages and increased collagen bundles in papillary dermis (× 20, H&E)

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Table 1: Morphologic characteristics of parapsoriasis patients before and after phototherapy

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In conclusion, single lymphocyte epidermotropism was the most prominent finding before treatment, lack of epidermal and dermal lymphocytic inflammation should be emphasized as successful parameters of NB-UVB/PUVA treatment including dermal fibrosis and melanophages [Figure 4], the histopathologic findings before and after treatment were similar between the SPP and LPP groups, and the histopathologic findings before and after treatment were similar among cases with and without recurrence.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Duarte IA, Korkes KL, Amorim VA, Kobata C, Buense R, Lazzarini R. An evaluation the treatment of parapsoriasis with phototherapy. An Bras Dermatol 2013;88:306-8.  Back to cited text no. 1
    
2.
Väkevä L, Sarna S, Vaalasti A, Pukkala E, Kariniemi AL, Ranki A. A retrospective study of the probability of the evolution of parapsoriasis en plaques into mycosis fungoides. Acta Derm Venereol 2005;85:318-23.  Back to cited text no. 2
    
3.
Baderca F, Chiticariu E, Baudis M, Solovan C. Biopsying parapsoriasis: Quo vadis? Are morphological stains enough or are ancillary tests needed? Rom J Morphol Embryol 2014;55:1085-92.  Back to cited text no. 3
    
4.
Massone C, Kodama K, Kerl H, Cerroni L. Histopathologic features of early (patch) lesions of mycosis fungoides: A morphologic study on 745 biopsy specimens from 427 patients. Am J Surg Pathol 2005;29:550-60.  Back to cited text no. 4
    


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