Parapsoriasis- A diagnosis with an identity crisis: A case report.

Summary: Introduction: Parapsoriasis is an uncommon inflammatory skin condition, often confused with psoriasis, and carries a risk of progressing to lymphoma. Due to its rarity, clinical guidelines for diagnosis and management are limited. Observation: we present a case of a 57-year-old woman referred from Muhimbili National Hospital for itchy skin lesions persisting for 4 years. Initially, she had a scaly patch on her chest, treated with over-the-counter products without improvement. The condition spread, and fluconazole treatment at another hospital failed. A biopsy at the national hospital was inconclusive, leading to a referral to RDTC. On examination, she had generalized atrophic skin with some sparing areas and widespread hypopigmented macules. We had a differential diagnosis of parapsoriasis variegate, ruling out cutaneous T-cell Lymphoma. All blood workups were normal; multiple biopsies were taken and showed atrophy of the epidermis, hypergranulosis, and necrotic keratinocytes with lymphocyte and vascular proliferation within the papillary dermis. We managed the patient with topical corticosteroids and regular follow-up. Conclusion: Parapsoriasis variegate presents with nonspecific clinical and histopathological features, making differentiation from Mycosis Fungoides challenging. Regular follow-up is crucial due to the risk of malignant transformation.