Ichthyosiform Large Plaque Parapsoriasis: Report of a Rare Entity
A 36 year old male patient presented to us with almost asymptomatic ichthyosiform lesions of three years’ duration which appeared gradually involving mostly the trunk and extremities. [Figures -] At the time of reporting lesions also started appearing over the sides of the face. The lesions were ichthyosiform patches of varying sizes measuring five to ten centimeters in diameter, the borders of which merged with intervening normal skin. The dry adherent pigmented scales were of varying shapes and sizes with mild telangiectasia noted over few lesions. There was no anesthesia either over the lesions or peripherally in glove and stocking distribution. There was history of application of emollient and topical corticosteroids with neither any change in the morphology of the lesions nor their size. There was no history of systemic medication prior to or during the course of the disease. No abnormalities were detected in general survey and systemic examination including absence of lymphadenopathy. A provisional diagnosis of ichthyosiform MF was made. Routine investigations including complete hemogram, chest X-ray, Mantoux test were within normal limits as was his thyroid profile. Histopathological examination of biopsy specimen revealed mild hyperkeratosis with localized parakeratosis, irregular acanthosis and mild spongiosis. [] Upper dermis contained dense lymphocytic infiltrate without any evidence of nuclear atypia or epidermotropism []. There was no granuloma formation. Immunohistochemical study of infiltrate expressed CD3, CD2, CD5 and CD4 but was negative for CD20, CD8, CD7 and CD30.\nThe above findings prompted us to reconsider our diagnosis to ichthyosiform LPP. The patient was put on systemic phototherapy, but without any improvement even after three months of treatment.