curs lichen plan

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LICHEN PLAN

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Definitie

Afectiune cutaneo-mucoasa, papuloasa,

pruriginoasa, cu evolutie cronica,

autolimitata

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Epidemiologie

• Prevalenta 0,5-1%

• Apare la orice varsta, mai frecvent

decadele 5-6

• Afecteaza egal ambele sexe

• Uneori poate avea caracter familial

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Etiopatogenie

Etiologia este necunoscuta. Factoriincriminati:

• Infectii virale• Afectiuni neurologice (asoc LP cu

nevrite periferice, gruparea liniara a lez)

• Medicamente (antimalarice)• Autoimuna (asoc cu GVHD, hepatite

virale cronice, ciroza biliara primitiva)

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Manifestari clinice

• Debut insidios (rar acut)

• Papule mici 1-3 mm, violacee,

stralucitoare, lucioase, cu reticulalbicios pe suprafata (Whickham),

uneori ombilicate

• Prurit

• Vindecare cu hiperpigmentare reziduala

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Manifestari clinice

• Fen Kobner prezent

• Zone afectate:

 – Reg ant a art pumnului

 – Reg lombara

 – Reg maleolara

 – Gambe

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Afectarea unghiala

• La 10% din cazuri

• Subtierea proximala a lamei unghiale

• Pterigium unghial

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Afectarea parului

• Intalnita in LP folicular 

• Determina placi alopecice cicatriciale

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Forme clinice

• LP hipertrofic - noduli pe gambe

• LP inelar - papule grupate pred lombar saupenian

• LP folicular (LP pilar)

• LP liniar 

• LP acut

• LP al palmelor si plantelor - aspect decalozitati galbui cu halo inflamator 

• LP veziculo-bulos

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Histopatologie

• Epiderm:

 – Hipergranuloza focala

 – Acantoza neregulata (“in dinti defierastrau”)

 – Degenerescenta hidropica cel bazale

• Derm – Infiltrat inflamator limfocitar “in banda”

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Prognostic

• Evolutie autolimitata

• Formele mucoase sunt mai recalcitrante

• 15-20% din pacienti pot prezenta

recurente

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Tratament

• Corticosteroizi (topici si rareori

sistemici)

• Retinoizi

• Fototerapie (PUVA)

• Asociere retinoizi-PUVA (Re-PUVA)

• Ciclosporina