Clinic And Pathologic Analysis Of99Patients With Parapsoriasis

[Objective]Study the clinical feature and pathologic character of parapsoriasis and investigate the relationship between the clinical and pathology. Provide more perfect theoretical foundation for the diagnosis and treatment of this disease.[Methods]99parapsoriasis patients from the First Union hospital of Kunming Medicai University which had been diagnosed by clinical character and skin biopsy between Jan2010and Mar2013were reviewed.Analyse the clinical and pathological character by Combined with clinical and pathological data of selected subjects and grouped according to different conditions.[Results]1. According to our information,the onset of parapsoriasis generally occurred in the middle-aged especially30～39years old (mean age31.68±17.90),with the ratio of male to female1.20:1. There are no significant difference between the onset of men and women(x2=0.91, P>0.05).2. The lesions always both involved torso and limbs(rate41.41%), Followed with most part of body(rate41.41%). Only involving limbs(rate16.16%),.The least group was only involving torso(rate7.07%). Comparising among groups, the difference has statistically significance(x2=0.91, P<0.05).3.35.35%cases had no self-conscious symptom.18.18%cases had mild itching.23.23%cases had obvious itch.4.04%cases had both itch and pain. Comparising among groups, the difference has the most statistically significance(χ2=27.07, P<0.01).4. Both clinic and pathology of parapsoriasis are divided into four types:4.1PLC is one of the most common type(rate63.63%) and the average course of the disease is17.04monthes. Its histopathology is characterized by subacute or chronic inflammation of destruction of the epidermal basal layer.4.2PLEVA:The course of it is short with the average2.98monthes. Clinical manifestations have both scattered pimples and scabby damage. Patients had sunk and atrophic scar(rate43.49%). Its histopathology is characterized by skin cell necrosis in different level and the lymphocytic vasculitis changes in dermis. The patients were seen visible red cells spillover around the vessels(rate26.09%). In this group of patients, one case was diagnosed of febrile ulceronecrotic Mucha-Haberman disease (FUMHD).The patient had a fever.The skin lesion was characterized by extensive necrotic papulas and maculopapules, deep ulcers.The patient had a severe disease and histopathology was characterized by epidermal necrosis, fibrinoid degeneration and necrosis in the walls of vessel.At the same time serious lymphocytic infiltration of walls and sides of vessel can be observed.4.3SPP and LPP:The number of SPP and LPP cases are less(each rate6.06%and7.07%). Histopathology is characterized by zonal lymphocytic infiltration under the epidermis. A few lymphocytes immersed in skin. There were3patients which were seen mild special-shaped lymphocyte infiltration in the epidermis or dermis.5. In this experiment, the clinical misdiagnosis rate of parapsoriasis is18.18%.The main misdiagnosis are:mycosis fungoides(MF), eczema, lymphomatiod papulosis, pityriasis rosea, lichen planus and psoriasis vulgaris.[Conclusion]1. Both clinic and pathology of parapsoriasis are divided into four types.Each type has its characteristic changes.2. the onset of parapsoriasis generally occurred in the middle-aged. The lesions always both involved torso and limbs. Most cases had no self-conscious symptom or had mild itching.3. The course of PLEVA is short. It is an acute disease.The lesion always involves most parts of body.But the course of LPP is long. Partial LPP cases may evolve into MF. We need to strengthen the clinical observation and histopathological follow-up.4. Plaque parapsoriasis closely associates with MF. Histopathological is an important means of identification each other. When it is necessary, immunohistochemistryl and lymphoid cell receptor gene rearrangement may also help.5. FUMHD is a severe acute subtype of PLEVA, often with a high fever and multi-system involvement. Its histopathology is characterized by severe epidermal necrosis and fibrinoid degeneration and necrosis in walls of many vessels.The patients had a high mortality.