18 year old male with complaints of mildly pruritic irregular patches on body from 2 -3 months involving trunk and upper extremity... on scraping mild scaling was present...kindly diagnose the case and give management


In Parapsoriasis, Digitate pattern is a distinctive form consisting of palisading elongated fingerlike patches that follow the dermatome and are most prominently displayed on the lateral thorax and abdomen. Histopathology Mentioned does not support either small plaque or large plaque parapsoriasis. Because it shows a mixed report. Ideally In small plaque parapsoriasis The epidermis may show mild spongiosis, focal hyperkeratosis, scale crust, parakeratosis, and lymphocytes are not remarkable. In large plaque parapsoriasis, a superficial dermal inflammatory infiltrate consists predominantly of lymphocytes. Numerous lymphocytes abut the dermal-epidermal junction and single lymphocytes can be observed in the epidermis. The epidermis shows flattening of the rete ridges. Acanthosis of the epidermis and irregular hyperkeratosis of the cornified layer are present. In contrast to small plaque parapsoriasis, spongiosis is absent.

A good Histopathology report and A complete blood cell count with differential should be performed, and a high lymphocyte count or the presence of Szary cells suggests mycosis fungoides/cutaneous T-cell lymphoma which needs immediate treatment.

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Dr Mayank I agree with Dr mohan and Dr Asha It's pityriasis rosea Treatment Moisturising Calosoft lotion in morning and Mometasone cream In Night as spot application. Don't over apply. Antihistamines fexofenadine or ebastine is non sedative for school and college goers. Moisturising soap Casil or aquasoft soap. In case of non responder a course of 10 says methyl prednisolone 4mg in morning only. Acyclovir is also Treatment option

Look for Herald or Mother's patch.

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The lesion and the biopsy showing keratosis with dermal lymphatic infiltration is indicative of lichenoid dermatitis, treatment is topical steroids,moisturizer with lactic acid urea,systemic vita A,PUVA.

Scaling is only clue..in addition to Pruritus.. so can be Psoriasis. Seborhic dermatitis.. Lichenoid eruption..

Tinea versicolor

why not parapsoriasis

Definitely a possible DD which needs to be looked into.

pityriasis rosecea


pictures download was late but still looks s.dermatitis

Pityriasis rosea ? The rash can sometimes last for 2-3 months.

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