Conditions characterized by the presence of elevated lesions, papules measuring less than 1cm, plaques measuring greater than 1cm, and scales.

For many papulosquamous disorders, the cause may be unknown. Factors that may be contributors to these conditions include chemicals, certain medications, infection, immunodeficiency disorders, stress, and chronic graft-versus-host disease. Certain skin lesions may be secondary to or associated with other diseases or malignancy.

The inclusive papulosquamous disorders included in this diagnostic code have varying signs and symptoms.

• Manifestations of lichen planus include a gradual or sudden onset of a small (pinhead-size), itching, flat-topped, brightly colored red or violet, bumpy rash that turns into rough, scaly, raised plaques. Mouth sores are common. Other common body sites include the body trunk, inner surfaces of the wrists, legs, genitalia, and vaginal mucosa. Leg lesions may become especially large and scaly. Rashes on the scalp may sometimes result in patchy baldness.

• Both small and large lesions of plaque parapsoriasis manifest with scaly, red lesions that appear thin, salmon-pink with fine, white scales.

  • The small-plaque version commonly appears on the body trunk, but can scatter throughout the body. These lesions may measure 0.5cm to 5.0cm.

  • The large-plaque version is most commonly seen in the area of the waist, and is accompanied by fine wrinkling from atrophy of the epidermis. These lesions may be 6cm or larger.

• Pityriasis lichenoides et varioliformis acuta (PLEVA), also known as Mucha-Habermann disease, is characterized by discrete, red, fluid-filled papules on the skin over the trunk and extremities that bleed, crust, and scale, and leave scars. The lesions clear spontaneously after weeks or months.

• Lymphomatoid papulosus manifestations appear as lymphoma-like involutional, purple-red papules, plaques, and nodules that may come and go.

• Pityriasis rubra pilaris (PRP) manifests as persistent exfoliative dermatitis [see diagnostic code: 7817 erythroderma]. It manifests with red, rough, scaling plaques and patches that have follicular horny excretions. Although the entire body can be involved, the usual distribution is on the back of the hands and fingers. There may be yellow hyperkeratosis of the palms and soles.

Lymph node biopsy or skin biopsy may be done to differentiate and confirm a diagnosis due to the many conditions these diseases resemble. Cultures may also be indicated.

Some conditions clear up without treatment, but may take years to remiss. Other treatments may depend on the disorder, and may include discontinuing a potential causative agent; use of local therapy for itching, such as antihistamines; topical, oral, or systemic corticosteroids; and mouthwash containing lidocaine, such as Xylocaine viscous, which may be used for painful mouth sores.

Large plaque parasporiasis can progress to cutaneous T-cell lymphoma (CTCL). Lichen planus episodes may recur for years. Residual dark discoloration remains after the rash heals. Long-standing mouth sores have the potential to result in oral cancer. PLEVA may persist for years. Certain disorders may require prolonged treatment during outbreaks of the disease.

Mycosis fungoides is a cutaneous manifestation of T-cell lymphoma that typically presents as some form of skin lesion and rarely progresses beyond the skin. For rating purposes, it is not considered a systemic malignancy. As such, it should be evaluated under diagnostic code 7822. If the condition progresses to a lymphoma with appropriate diagnosis, such as non-Hodgkin's lymphoma (active disease/active treatment phase), it would warrant an evaluation under diagnostic code 7715.

• 38 CFR 4.118 (a) For the purposes of this section, systemic therapy is treatment that is administered through any route (orally, injection, suppository, intranasally) other than the skin, and topical therapy is treatment that is administered through the skin.   

• 38 CFR 4.118 (b) Two or more skin conditions may be combined in accordance with 38 CFR 4.25 only if separate areas of skin are involved. If two or more skin conditions involve the same area of skin, then only the highest evaluation shall be used.