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Large plaque parapsoriasis: clinical and genotypic correlations.

M Simon¹, M J Flaig, P Kind

¹Department of Dermatology, Ludwig-Maximilians-University, Munich, Germany.

Journal of Cutaneous Pathology

|March 11, 2000

Summary

T-cell receptor (TCR) gene rearrangement analysis in large plaque parapsoriasis (LPP) did not predict disease progression. Findings suggest LPP and early mycosis fungoides (MF) are clinically indistinguishable and should be termed early MF.

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Area of Science:

Dermatology
Immunology
Oncology

Background:

Large plaque parapsoriasis (LPP) and early mycosis fungoides (MF) present similar clinical and histological features.
Distinguishing between LPP and early MF is challenging, impacting diagnosis and prognosis.

Purpose of the Study:

To investigate the diagnostic and prognostic significance of T-cell receptor (TCR) gamma-chain gene rearrangement in LPP.
To assess if TCR gene status can differentiate LPP from early MF.

Main Methods:

Analysis of T-cell receptor (TCR) gamma-chain gene rearrangement in skin biopsies from 12 LPP patients.
Correlation of TCR gene rearrangement status with long-term clinical follow-up.

Main Results:

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Six out of 12 LPP patients exhibited a clonal T-cell population.

One patient with a clonal T-cell infiltrate progressed to mycosis fungoides (MF) after 8 years.

No progression to MF was observed in the remaining 5 patients with clonal disease or in those with polyclonal infiltrates over 2-21 years.

Conclusions:

TCR gene rearrangement status has no prognostic significance in LPP.
TCR gene status does not distinguish LPP from early MF, as both show similar clonal T-cell infiltrates and progression risk.
LPP and early MF represent the same clinical entity, best designated as early MF, necessitating focus on identifying high-risk patients.