Claire Bernier, Jean Michel Nguyen, Gaëlle Quéreux, Jean Jaques Renault, Brigine Bureau, Brigitte Dreno
DOI: 10.2340/00015555-0197

Making a differential diagnosis between early mycosis fungoides (MF) and parapsoriasis is often difficult at the clinical and histological level. The aim of this study was to explore markers that could help in this process. A total of 88 patients were included in 2 categories: large plaque parapsoriasis and digitiform parapsoriasis. A histological examination was performed for each patient, and expression of the antigen My7 (CD13), which is lacking in cutaneous T-lymphomas (CTCL) (but not in inflammatory lesions) and rearrangement of the T-cell receptor gene were analysed. A histological aspect of epidermo­tropic CTCL was observed in 23.5% of cases of large plaque parapsoriasis and 15% of cases of digitiform para­psoriasis. A disappearance of My7 antigen was noted in the 2 forms of parapsoriasis, more frequently when there was CTCL histology. A cutaneous clone was observed in 10.3% of cases of large plaque parapsoriasis, but not of digitiform parapsoriasis. For 3 patients, a cutaneous clone and a disappearance of My7 were associated with a non-specific histology. Considering these histological, immunological and molecular biological data, it appears that My7 antigen combined with T-cell clone may help the dermatologist to confirm the diagnosis of early MF. Moreover, further studies will determine whether CD13 is an early prognostic marker of evolution of a para­psoriasis to MF. Finally, these results demonstrate that digitiform parapsoriasis can be an early stage of MF.