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Answer to your Health Question


Is there any alternative treatment for parapsorias?




Dear Larry,

Because of the variation in clinical presentation and a lack of a specific diagnostic finding on histopathology, a uniformly accepted definition of parapsoriasis remains lacking.

There are 2 general forms: a small plaque type, which is usually benign, and a large plaque type, which is a precursor of cutaneous T-cell lymphoma (CTCL).

Treatment of small plaque parapsoriasis is unnecessary but can include emollients, topical tar preparations or corticosteroids, and/or phototherapy.

Treatment of large plaque parapsoriasis is phototherapy or topical corticosteroids.

The duration of parapsoriasis can be variable. Small plaque disease lasts several months to years and can spontaneously resolve. Large plaque disease is chronic, and treatment is recommended
because it may prevent progression to CTCL.

No definitive studies have been published regarding therapy of parapsoriasis. When treated, most patients are initiated empirically on topical steroids or phototherapy. Typically, patients will have partial responses and/or relapse off any therapy.

A rational therapeutic strategyfor parapsoriasis is lacking because there are no longitudinal studies that correlate treatment response and impact on progression to CTCL.

Bexarotene, a resinoid, a subclass of retinoids that binds preferentially to nuclear retinoic X receptors (RXR), has therapeutic activity in CTCL.

Bexarotene 1% gel has been approved for treatment of CTCL and found to have up to a 63% response rate in Stage Ia to IIa CTCL.

Psoralen and long-wave ultraviolet light A (PUVA) shows promise in managing and eliminating large plaque parapsoriasis. The therapy is most effective in conjunction with radiation during the earliest stages of disease.

A study conducted by the Department of Dermatology, Sahlgrenska University Hospital in Göteborg, Sweden, found that PUVA combined with limited radiation generated remission in 22 of the 24 patients involved in the study.

The patients who had only LPP (Large plaque parapsoriasis) that hadn't progressed to skin cancer maintained remission for at least 18 years with one treatment.

Those who had developed mycosis fungoides (first-stage CTCL) required multiple treatments, but their disease didn't progress and remission lasted three to 18 years. Two patients with advanced CTCL died during the study.

Side effects of PUVA include nausea, vomiting, itching and skin irritation at the treatment site.

Narrow band (311 nm) ultraviolet B (NB-UVB) phytotherapy are safe and effective to manage SPP (Small plaque (digitate) parapsoriasis). Researchers at the Department of Dermatology, University of Munich, Germany, used NB-UVB to treat 16 patients with SPP in 1996.

Initial remission lasted approximately 29 weeks, but after an average of 32 treatments, all patients had full remission.

NB-UVB has fewer side effects than PUVA and is the preferred method for treating SPP (Small plaque (digitate) parapsoriasis) when steroids prove ineffective or there are multiple lesions

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