Papular Lesions Research Articles

Chronic Urticaria: Seeking the Causes in Iranian Population

Background: Chronic urticaria (CU) is the recurrence of erythematous itching papular skin lesions for at least 6 weeks. Although it is often considered a benign condition, there are reports of the association of chronic idiopathic urticaria with infections, thyroid disease, foods, medications, autoimmunity, neoplasms, and low serum level of vitamin D. We aimed to identify the effect of lifestyle characteristics, environmental factors, family history, and specific comorbidities as potential external eliciting factors on the onset of chronic urticaria. Materials and Methods: The present research was conducted on 141 adult patients diagnosed by CU at the allergy clinics of Azad University hospitals in Tehran from January 2021 to January 2022. A questionnaire on different life events during the past 3 months before the onset of urticaria was developed to evaluate the characteristics of the patients with chronic urticaria. Meanwhile, 58 healthy individuals who were similar to the patients in terms of age range and gender were asked to participate in the study as the control group. Results: The mean age of the patients and the controls were 41.7 years and 39.8 years, respectively. The female and male patients were 105(74.47%) and 36(25.53%), respectively. Only two of the evaluated predisposing factors were meaningful including the use of new medications (23.4% versus 19%; P=0.006) and the co-existence of anxiety and depression (14.1% versus 4%; P=0.036). Conclusion: Among the different factors evaluated in this study, only two were found to be significant in relationship with CU which are anxiety/depression and medications.

PB2125: LYMPHOMATOID PAPULOSIS-LIKE (LYP-LIKE) AFTER BRENTUXIMAB VEDOTIN-CHP (BV-CHP) TREATMENT FOR ALK-NEGATIVE ANAPLASTIC LARGE CELL LYMPHOMA (ALCL)

Background: Lymphomatoid papulosis is an indolent form of CD30 primary cutaneous lymphoproliferative disorder characterized for recurrent crops of self-healing papular nodular lesions. Histological findings may overlap with those in primary cutaneous ALCL so clinical features and evolution determine the appropriate therapeutic approach. Most cases of LyP don’t require any treatment, but PUVA or low-dose oral methotrexate can reduce skin lesions. LyP-like is uncommon after a systemic ALCL. BV-CHP has become the new standard front-line treatment for ALCL in the last years; some aspects of the biological and clinical behavior of the disease with this new therapy are still under research. Aims: NA Methods: NA Results:Patient 1: 45 years female, diagnosed in January/20 with ALK-negative ALCL stage IV-A, IPI 3, involving multiple supra- and infradiaphragmatic lymphadenopathies, spleen, skin, bone and bone marrow. The diagnosis was performed by skin biopsy of an extensive ulcerated mass in the right chest area. FISH showed no rearrangements of DUSP22 and TP63. BV-CHP was started in January/20, achieving PR by PET-CT after 3 cycles. She completed 6 cycles. Four weeks after the last dose of chemotherapy she developed several papular skin lesions in the trunk and extremities. The skin biopsy was reported as ALCL. PET-CT showed metabolic CR at that time. After 3 weeks, the skin lesions spontaneously disappeared and she underwent ASCT conditioned with BEAM in July/20. Two months later, she developed new skin lesions and a new biopsy showed nonspecific findings: perivascular lymphocytic dermatitis with epidermal spongiotic changes. PET-CT showed two enlarged axillary lymphadenopathies with increased activity. A watch and wait strategy was adopted, until September/21 when she relapsed involving multiple lymphadenopathies, bone, spleen and new papulo-necrotic skin lesions. Skin biopsy showed a CD30+ lymphoprolipherative disorder. She received 3 cycles of ESHAP achieving PR, and an haploidentical stem cell transplantation was performed in January/22. Two months after transplant, the patient has no signs of disease and no skin lesions. Patient 2: 62 years male, diagnosed in August/21with systemic ALK-negative ALCL stage IV-B, IPI 3, with supra- and infradiaphragmatic lymphadenopathies and extensive colonic involvement. DUSP22-IRF4 and TP63 rearrangements were assessed, showing no abnormalities. Bone marrow and skin were not affected. He started front-line treatment with BV-CHP in September/21, with metabolic CR in the interim PET-CT after 4 cycles. He completed 6 cycles with good tolerance until late December/21. One month later, he developed papular and papulo-necrotic skin lesions in different evolutionary stages, affecting trunk, extremities and scalp. Skin biopsy was performed, showing a CD30+ lymphoprolipherative disorder. Another PET-CT demonstrated systemic CR. Clinicopathological findings were consistent with lymphomatoid papulosis. The patient underwent an ASCT as consolidation treatment. Currently, the skin lesions have involuted spontaneously. Image:Summary/Conclusion: These two similar cases illustrate an unusual scenario after systemic ALK-negative ALCL, both developed within weeks after frontline chemotherapy with BV-CHP. Diagnosis and therapeutic decisions are challenging. Further experience with this new regimen will reveal whether the addition of BV may play a role in the development of this condition, and whether the clinical course is the same as primary cases of LyP or precedes a relapse of systemic lymphoma.

Large bilateral corneal ulcers caused by debromoaplysiatoxin from the blue-green alga Lyngbya majuscula in a fisherman.

Toxic seaweed dermatitis is caused by toxins of the marine cyanobacterium Lyngbya majuscula after sea bathing in some tropical area. This rarely described irritant dermatitis results in papular and bullous lesions, mainly in the genital area but severe ocular lesions can occur.

Polymorphous light eruption in children – clinical presentation, differential diagnosis and treatment

Polymorphous light eruption is classified as an immune-mediated photodermatosis. It is the most common cause of photosensitivity in children between 6 and 14 years old. It is characterised by pruritic or tingling erythematous papular or plaque lesions of sunlight-exposed skin which occur in spring or early summer. The first signs of polymorphous light eruption typically appear several hours to days after the first exposure to intense sunlight and take the form of an irritable rash persisting for a few days, and subsiding within a week or two with minimal or no scarring. Its recurrences may have a detrimental impact on the quality of life. Due to the significant heterogeneity of clinical manifestations of polymorphous light eruption, the disorder is relatively challenging to diagnose. The differential diagnoses include photosensitivity associated with lupus erythematosus, solar urticaria, actinic prurigo, erythema multiforme, photocontact allergic dermatitis, and genetic dermatoses. UVA and UVB phototesting followed by histological examination is an important diagnostic tool to objectify light-related symptoms. Once the diagnosis is established, the patient should be monitored and educated on prevention. The management of polymorphous light eruption is based on prevention such as sun protection and sunscreens. The first-line treatment includes glucocorticoids and antihistamines.

Cutaneous manifestations of antineutrophil cytoplasmic antibody-associated vasculitis (AAV): a concise review with emphasis on clinical and histopathologic correlation.

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) comprises a group of small vessel vasculitides grouped by commonalities of clinical manifestations and ANCA testing. Skin findings are not uncommon, although there is considerable overlap and many times nonspecificity. In general, patients with skin findings tend to have more significant systemic illness, and skin lesions most often develop simultaneously or following onset of systemic symptoms. There are clinical and pathological clues of help in the differentiation of skin findings in these disorders. Purpura of various forms with leukocytoclastic vasculitis is common to all AAV. Granulomatosis with polyangiitis (GPA) comprises the largest number of patients with an AAV. Upper airway, oral, ear, and facial lesions, with or without granuloma, are more commonly seen in this AAV. Pyoderma gangrenosum-like lesions, including facial location, while not common are most closely associated with GPA. Eosinophilic granulomatosis with polyangiitis (EGPA) as its name implies is more closely associated with eosinophilic, allergic, or asthmatic conditions. Papular lesions of the extensor extremities showing extravascular granulomatous changes are characteristic but not specific for EGPA. Microscopic polyangiitis (MPA) is more closely associated with livedoid skin changes, and vascular inflammation tends to be deeper in the skin than with the other AAV. Extravascular granulomas are not expected. While the skin findings in AAV can be nonspecific and overlapping, combining careful full skin examination with histopathologic study of selected lesions is critical to making the correct diagnosis and in ruling out other similar diseases not ANCA related. The aim of this article is to encourage increased participation by dermatologists and dermatopathologists in the care of these patients.

The use of radio-wave surgery: An underestimated method for small hyperpigmented flat or macular lesions on face.

Although choosing the appropriate treatment method is relatively easy for papular or protuberant lesions, for small macular lesions it may not be so, because they are generally percepted as mild lesions by the patient and she/he usually has the anxiety of final disfigurement which may result esthetically worse than the original one. It is reasonable to choose the method which will reveal the least scar formation and lowest recurrence rate with cost-effectiveness, in removal of superficial small macular lesions for cosmetic purposes. Fifty-six male and female patients with small hyperpigmented flat or macular lesions, less than or equal to 5mm diameter on their face, who referred to hospital dermatology clinic for removal and received an interventional therapy with a radio-wave surgery unit in the years 2018-2019 were retrospectively recruited. Besides the observation of scar formation and residual erythema, 3-month recurrence rates were also analyzed. At the end of 3months, there was no scar on any lesion site. Mild erythema was detected on 15lesion sites out of a total of 218 (6.9%).The total recurrence rate was 7.7%. The mean age of the patients with at least one recurrence was significantly greater than the patients with no recurrence, and the lesions greater than 3mm were more prone to recur than the lesions less than or equal to 3mm. Although no method of lesion removal can warrant a scarless result without recurrence, for benign macular hyperpigmented lesions of the face up to 5mm in diameter, radio-wave surgery may be preferred due to both its minimal scar formation and recurrence rate, in addition to its cost-effectiveness.

Clinical Features and Follow-Up of Prurigo Pigmentosa: A Case Series.

IntroductionPrurigo pigmentosa (PP) is an underrecognized disease in the Western population. Our aim is to describe the clinical features and follow-up outcomes of Caucasian patients diagnosed with PP.MethodsThis case series was conducted in the dermatology outpatient clinic of a tertiary hospital. Patients with confirmed PP from May 2020 to June 2021 were included in the study. Patient demographics, clinical features, potential triggers, treatment and follow-up data were recorded.ResultsA total of eight patients with female predominance were identified. The mean age of the patients was 24.5. The duration of symptoms ranged from four days to six months. All patients presented with pruritic, papular or papulovesicular lesions. Net-like hyperpigmentation was also present at the initial visit in two patients, in whom the duration of the symptoms was the longest. Lesions were most commonly located on the chest and back. Six of eight patients reported alteration of diet that potentially led to ketosis. Doxycycline 200 mg daily for two weeks led to a complete response in all six medically treated patients. Duration of follow-up ranged from 1-14 months (mean: 7.2 months). In five patients with a follow-up duration of more than three months, postinflammatory hyperpigmentation was resolved without any treatment. Only one patient had a recurrence.ConclusionPP does not seem to be a rare disease. Young women are most commonly affected, and ketosis stemming from decreased calorie intake may be the etiological factor in the majority of the patients. Dermatologists should be familiar with early signs of PP in order to minimize unnecessary therapies, recurrences and long-lasting hyperpigmentation.

Cutaneous histoplasmosis. A case report

Histoplasmosis is an endemic infection of Ecuador, its forms of presentation can be varied and florid, especially in immunosuppressed patients, its lethality is high, hence its diagnosis and treatment should be based on both clinical and laboratory results. Cutaneous histoplasmosis is a form of disseminated Histoplasma capsulatum infection rarely described in HIV patients. The following is a description of the diagnosis and treatment of a patient with generalized papular skin lesions, heat stroke, diarrhea, attributed to adverse reaction of gastritis treatment of 10 days of evolution, this was associated with a recent diagnosis of HIV infection following his admission to hospital.

Molluscum Contangiosum Diagnosis, Manifestation and Management: A review Article

Introduction: Infectious skin disease with clinical manifestations of benign papules, which is often caused as a sexually transmitted disease in adults, caused by the molluscum contagiosum virus, a member of the poxvirus. Manifestations of the disease are asymptomatic, discrete, smooth papules. It usually develops from peduncled lesions up to 5 mm in diameter. The incubation period for Molluscum contagiosum is from one to several weeks to 6 months. Molluscum contagiosum is a viral infection that can heal spontaneously. There are 4 main subtypes of Molluscum Contagiosum 4 Virus (MCV), namely MCV I, MCV II, MCV III and MCV IV. These four subtypes cause similar clinical symptoms in the form of papular miliary lesions that are limited to the skin and mucous membranes. MCV I is known to have a greater prevalence than the other three subtypes. About 96.6% of molluscum contagiosum infections are caused by MCV I. However, in patients with decreased immune status, the prevalence of MCV II is 60%.

A study of dermoscopic patterns of Wickham's striae in lichen planus

<p><strong>Background:</strong> Wickham striae corresponds to fine white or gray lines or dots seen on the top of the papular rash and oral mucosal lesions of lichen planus. The documented types of Wickham’s striae dermoscopic patterns are linear, reticular, circular, globular, star-burst, radial and leaf-like. Aim was to study and describe the dermoscopic patterns of Wickham’s striae in lichen planus.</p><p><strong>Methods:</strong> A prospective study was conducted between December 2019 to March 2020, among outpatients in the department of dermatology, venereology and leprosy in a tertiary care hospital. The lichen planus lesions including Wickham striae pattern were visualised with the dermatoscope (DermLite DL 4) and documented.</p><p><strong>Results:</strong> The 20% had the circular pattern, 10% radial streaming, 4% leaf venation and 2% starry sky appearance. Other pattern observed were linear which was seen in 6% of the patients. They were seen associated with lesions over the lip. Vascular patterns were noted only in 20% of the patients with most of them having dotted patchy type of vessels.</p><p><strong>Conclusions:</strong> With dermoscopy, the Wickham’s striae are the diagnostic key to differentiate lichen planus from other papulosquamous disorders. In our study we were able to see various patterns of Wickham’s striae including a less reported form like leaf venation.</p>

Linear immunoglobulin A bullous dermatosis with severe ocular and oropharyngeal involvement

Linear IgA bullous dermatosis (LABD) is a rare chronic autoimmune epidermal disorder that presents with bullous and vesicular lesions affecting the skin and, more rarely, oral and ocular mucosa.1 This report describes a previously well 74-year-old man on no medications who presented with 3 months of oral mucosal ulceration causing dysphagia and odynophagia, bilateral ocular irritation and injection, and 6 months of cutaneous lesions. Clinical examination revealed multiple papular erythematous skin lesions on the trunk and axilla.

Classical Hodgkin Lymphoma Presenting as Cutaneous and Soft Tissue Mass Lesion: An Enigmatic Presentation Posing a Diagnostic Challenge—A Case Report and Review of Literature

AbstractHodgkin lymphoma (HL) is primarily a nodal disease. Cutaneous involvement of HL as a presenting feature is extremely rare. Skin involvement is usually seen as a metachronous involvement in the course of disease and is associated with poor prognosis. Primary skin and soft tissue involvement can be construed as nonhematological, inflammatory, or infective etiology. We report a 14-year-old girl with fever, weight loss, lymphadenopathy, and multiple papular lesions over the right chest wall as initial manifestation of HL, posing a diagnostic challenge. In view of stage IVBE, patient was managed with intensive chemotherapy regimen and is currently free of disease at 6 months of follow-up.

A row of nodules on the right side of the face

A row of nodules on the right side of the face

CD8+ mycosis fungoides: A wolf in sheep’s clothing?

Sir, CD8+ mycosis fungoides (MF) is a rare form of MF with an indolent course. Herein, we report a rare case of CD8+ fungoid mycosis preceded by lymphomatoid papulosis type D with an aggressive course. A 36-year-old female presented with several papular lesions on the trunk and extremities with a relapsing–remitting course. Histopathology and an immunohistochemical study confirmed CD8-positive lymphomatoid papulosis type D and methotrexate at 25 mg/week was initiated. After a temporary clinical improvement, the lesions worsened, became infiltrated, and grouped as vaguely annular and angular patches with serpiginous borders (Fig. 1). A second scalp biopsy was performed and a diagnosis of CD8+ MF was established. An extension workup was normal, and MF was classified as stage IB. PUVA therapy was started with acitretin at 25 mg/day. After four weeks from the beginning of treatment, the patches completely disappeared but with the concomitant appearance of four subcutaneous tumors. The evolution was spectacular in fifteen days, with the tumors rapidly increasing in size, becoming ulcerative and necrotic, and one being localized in the left cervical area compressing the upper respiratory tract (Fig. 2). A subsequent biopsy revealed massive epidermal and dermal large cell infiltration (Fig. 3a); the tumor cells were positive for CD3, CD8, and CD7 (Fig. 3b) and negative for CD4, CD5, CD3, CD2, and CD30. Antigen Ki-67 was expressed by more than 80% of T-cells (Fig. 3c). A cerebral and thoraco-abdominal CT scan revealed multiple axillary lymph nodes with hypermetabolism on a PET scan. An osteomedullar biopsy was normal, and lactate dehydrogenase (LDH) was increased to 358 U/L. Chemotherapy was performed, but the patient died after two cycles of CHOEP. In contrast to classical CD4+ mycosis fungoides, CD8+ MF is a rare cytotoxic phenotype constituting about 5% of all cases of MF [1]. It belongs to the first group of primary cytotoxic cutaneous lymphomas (PCCL) with a good prognosis, an indolent course, and a slow progression of the lesions over several years [2]. However, rare cases with a more aggressive course have been reported in the literature [3]. The main differential diagnosis of aggressive CD8+ MF is an aggressive epidermotropic cutaneous CD8+ lymphoma that is a rare cutaneous lymphoma with a poor prognosis due to rapid extracutaneous dissemination [4]. The prognosis of the CD8+ subtype of mycosis fungoides (MF) is controversial. More studies are necessary to clarify this subject.

Diagnosis of Post Kala Azar Dermal Leishmaniasis in Nonendemic Areas

Leishmaniasis is a heterogeneous group of disease caused by protozoans of the genus Leishmania, transmitted by Phlebotomus sandflies. Human leishmaniasis is usually classified as visceral, cutaneous (localized, diffuse, disseminated), mucocutaneous, and post-kala-azar leishmaniasis. Post-kala-azar leishmaniasis is a sequel of visceral leishmaniasis (VL) caused by Leishmania donovani (LD) and seen in India, Bangladesh, Nepal, and Sudan. In India, it develops in 5%–15% of treated VL cases within 2–5 years. It is characterized by multiple papular, nodular, and pleomorphic lesions over the sun-exposed areas such as face, neck, and arms, without systemic manifestations. It mimics a wide range of dermatoses, particularly leprosy in endemic areas for both the diseases. Inadequate immune response (Th1 and Th2) to infection during and after the treatment of VL plays a role in the pathogenesis. It is thought to be a good reservoir of LD and plays an important role in the treatment of VL. Post-kala-azar dermal leishmaniasis (PKDL) is usually diagnosed by skin smears, immunological tests such as rK39, cutaneous leishmaniasis detection tests, and polymerase chain reaction. A combination of liposomal amphotericin B and miltefosine is the first line of treatment. PKDL is a forgotten clinical entity in the nonendemic areas. We report a case of PKDL in a 52-year-old male from Andhra Pradesh, a nonendemic area for leishmaniasis. This case was treated successfully with combination therapy, liposomal amphotericin B, and miltefosine.

Dermoscopic findings of hemosiderotic dermatofibroma: A comprehensive review

Dermatofibroma (DF) is a very common benign skin tumor composed of fibroblasts, histiocytes, capillaries and collagen with multiple clinical presentations and histological variants [1]. DF usually affects female patients at any age between 10 and 75 years old [2-4]. Most of the time it presents as a single, firm papular lesion with a slightly keratotic surface, sometimes brown pigmented or skin tone, and frequently present in the inferior extremities. Almost 6% of all dermatofibromas are associated with trauma [2, 5]. Diagnosis is clinical and dermatoscopic patterns have been described as diagnostic tools. The most common presentation seen in 30-60% of all DF is a central scar-like patch with a peripheral reticular network [2, 3, 5, 6]. Nevertheless, atypical patterns simulating melanomas, vascular tumors or basal cell carcinomas have been described in another variants of DF such as hemosiderotic dermatofibroma [2, 3].

Энтеровирусный везикулярный стоматит как проявление энтеровирусной инфекции. Лекция

Lesions of the oral mucosa may be a sign of systemic human diseases. Most of manifested in the oral cavity diseases are benign, but it is necessary to differentiate them from more serious diseases. Dentists should know the manifestations and recent advances in the diagnosis and treatment of oral diseases, among which are viral infections, especially highly contagious, which include hand-foot-and-mouth disease. In order to prevent its spread and to identify in time possible complications, dentist should have deep knowledge about it. Hand-foot-and-mouth disease is a highly contagious viral infectious disease caused by various enteroviruses. Viruses of the genus Enterovirus are RNA genomic. It is necessary to know the main stages of the reproduction of RNA genomic viruses in the human body. 1. Adsorption on a cell (adhesion) – an interaction between specific receptors of virions and surface molecules of sensitive cells. 2. Penetration into the cell and "undressing" can be carried out in two ways: endocytosis and translocation. 3. The synthesis of viral particles of RNA-viruses (translation) – as a result specific proteins for viral replication are synthesized. 4. Complete assembly of RNA-viruses. 5. Release of daughter virions from the cell. The source of infection can be both a sick person and a virus carrier. Asymptomatic carriage can last for weeks, sometimes months. The most intense pathogen is released in the first days of the disease. The predominant morbidity of children speaks about the high natural susceptibility of a human. For diseases, which are caused by enteroviruses, polymorphism of clinical manifestations is specific. In most cases, the violation of the general condition is insignificant and the course of the disease is benign. The initial phase is usually followed by enanthema and erythematous, papular or vesicular lesions of the skin, localized mainly on the palms and soles, as well as vesicles in the oral cavity. Enanthema usually precedes the appearance of a skin rash. Oral lesions may occur without skin symptoms. Diagnosis of enteroviral vesicular stomatitis is based on anamnestic and clinical data. There are many diagnostic tests available, but PCR of throat and vesicular fluid swabs, if available, is one of the most effective. After an illness, in most cases, immunity is formed, the possibility of developing cross-immunity to other types of the virus is not excluded

Surgical extraction of an unusual macrocystic lymphatic malformation in the buttock: case report

BackgroundMacrocystic lymphatic malformation is a rare benign skin disorder, especially the anogenital area, which covers less than .5% of the reported cases. It can cause vesicular and papular lesions on the face, trunk, extremities, and, less frequently, anogenital areas. Although there are currently several therapeutic options, surgical excision is the most widely used, considering the lowest recurrence rate.Case presentationIn this article, we describe the case of a 15-year-old male patient who presented with herpetiform skin lesions, corresponding to the diagnosis of macrocystic lymphatic malformation, in the lower region of the right buttock. After confirmation of the diagnosis by histopathology, surgical excision was performed with a tensor fascia lata graft, with successful aesthetic and functional results.ConclusionsConsidering the diagnosis of macrocystic lymphatic malformation is of utmost importance, although its presence is unusual, to differentiate it from other herpetiform lesions. Despite the existence of multiple approaches today, definitive treatment with surgical extraction is necessary, both to improve the cosmetic aspect and to prevent associated complications. It is suggested that histopathological and imaging diagnostic tools be used as a routine element, in order to increase therapeutic success, as well as decrease the risk of recurrences.Evidence-based medicine rankingLevel IV

Atypical hand foot mouth disease presenting as vesiculobullous lesion

Hand, food, and mouth disease (HFMD) is a highly contagious disease caused by enteroviruses affecting young children under 5 years. Among enteroviruses (EVs), the main pathogens of HFMD are coxsackievirus A16 (CV-A16) and EV-A71 (EV-71).1 The clinical features include a prodromal phase which has low-grade fever, malaise and sore throat. This initial phase is usually followed by enanthem and erythematous papular skin lesions, predominantly affecting palms and soles. The dorsal surface of hands, feet, and perioral skin are rarely affected. Atypical HFMD presents as a widely distributed rash with varying morphology that makes clinical diagnosis and treatment challenging.2 Our objective is to present atypical cutaneous manifestations of HFMD caused by CA6.

Morphometric study of lymphangiogenesis in different lesions of psoriasis vulgaris with correlation to disease activity.

In the last decades, attention to the role of lymphangiogenesis in psoriasis has been paid. Our study was conducted to evaluate podoplanin-stained lymphatic vessels and the level of lymphangiogenesis in papular psoriatic lesions and psoriatic plaques and ascertain if podoplanin provides any additional prognostic information. Number of lymphatic vessels and total lymphatic vessel area were morphometrically analyzed in podoplanin-stained sections, using anti-D2-40, together with the immunohistochemical study of epidermal Ki-67 in psoriasis vulgaris (n=20) (papules=7 and plaques=13) and control skin specimens (n=20). The number of lymphatic vessels and total lymphatic vessel area were higher in psoriasis cases compared with normal skin (p=0.01, p=0.01 respectively). In psoriatic plaques, the number of lymphatic vessels, total lymphatic vessel area, and epidermal Ki-67 immunoreactivity were higher than in papular lesions (p=0.002, p=0.008, and p=0.01, respectively). Psoriasis vulgaris is found to be a lymphangiogenesis-dependent disease, and the lymphatic vascular network is in remodeling and expanding process. Podoplanin may be implicated in the pathogenesis of psoriasis and could be used as a prognostic biomarker for disease severity and progression.