Download - Parapsoriasis II
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Brocq 1902
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“Parches escamosos que simulan psoriasis”
Criterios clínico-patológicos originales:
Duración prolongada
Buen estado general de los pacientes
Ausencia de prurito
Resistencia a los tratamientos tópicos
Infiltrado linfocítico superficial perivascular
Telangiectasias y edema en dermis papilar
Espongiosis
Paraqueratosis
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Parapsoriasis en “gotas” = Pitiriasis liquenoides
Parapsoriasis “liquenoide”= Variante PPG poiquilodermica
Parapsoriasis en “placas”= PPP
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“Parches escamosos que simulan psoriasis”
Parapsoriasis en placas:
PPG a grandes placas poiquilodérmica / retiforme
PPP a pequeñas placas digitiforme
Pitiriasis liquenoide
PLCrónica (1899-Juliusberg)
PLEVA o PLYVA (1916 Mucha-Habermann 1925)
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PPG = “TNM0” de la Micosis Fungoides
PPP = Micosi Fungoides “abortada”
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Desorden linfoproliferativo del TLAP
Dermatitis CTCL
crónica
Micosis
Fungoides
Dermatitis
clonal
Dermatitis policlonal
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LCCT
MF
Dermatitis
clonal PPG EP
DECI
MFol
PPG: parapsoriasis grandes placas
Mfol: mucinosis folicular
E P: eritrodermia primaria
DECI: dermatitis espongiótica crónica
inespecifífica
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PPP
Ag peptidicos
Ag lipidicos
CL
CD dérmicas
HMC
CD-1a
TLAP
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Parches cobrizos, eritemato-descamativos, > 5 cm
Crónicos, asintomáticos o leve prurito
5° década, > H, cualquier raza y geografía
Tronco y extremidades, áreas cubiertas
“Poiquilodermia”: atrofia/telangiectasias/hipo-
hiperpigmentación
“Retiforme”: patrón en red o cebra diseminado
Riesgo: Un 10-30% desarrolla Micosis fungoides
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Parches asalmonados, eritemato-descamativos,
redondos u ovalados, < 5 cm
Crónicos, asintomáticos o leve prurito
5° década, > H, cualquier raza y geografía
Tronco y extremidades, áreas cubiertas
“Digitiforme”: parches alargados simétricos en
flancos, de 10 o + centrímetros
Riesgo: casi nulo de desarrollar M Fungoides
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Dermatitis espongiótica leve inespecífica y paraqueratosis
Infiltrado linfocitos CD-4+, perivasculares, superficiales, en la
interfase o liquenoides
PPG PPP
CD 4, HLA-II <<CD7 CD 4
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J Am Acad Dermatol 2005;53:1053-63
2
2
1
1
4
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PPG PPP
MF MF
Psoriasis Psoriasis
Erupción medicamentosa tipo MF Erupción medicamentosa tipo PRGibert
Enfermedad autoinmunitaria del tejido
conectivo poiquilodérmica PRGibert
Dermatitis de contacto-Tiñas Dermatitis numular
Radiodermatitis crónica Sífilis secundaria
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Siempre investigar !!!
PPG PPP
Micosis Fungoides Micosis Fungoides
Sífilis secundaria
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Primera línea
Emolientes
Corticoides tópicos
Alquitranes tópicos
Baños de sol
UVB banda ancha
UVB banda angosta
Segunda línea
Bexaroteno tópico Imiquimod tópico PUVA Mecloretamina tópica Carmustina tópica
(BCNU)
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Bexarotene gel 1%
PPP
Moderada irritacion
Desaparición entre 63%-100%
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PLEVA – PLYVA
PLCr
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Etiología desconocida: infecciones: Toxoplasma, virus: CMV, EB, HIV, Hepatitis B, Parvovirus B19, tratamientos hormonales, fármacos:tegafur, astemizol
Cualquier raza y geografía
Niños y adultos jóvenes
Predominio masculino
PLCr es 3 a 6 veces mas frecuente que PLEVA
PLEVA PLCr
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•Pápulas eritematosas, costras, vesículas
pústulas, erosiones
•Brotes recurrentes, tronco, miembros
•Pruriginosas o urentes
•Regresión espontánea en semanas
•Hipo-hiperpigmentación residual
PLEVA - PLYVA
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PLEVA: CD 8+
PLCr: CD 4 y CD 8+
LT: CD 45RO, TIA-1, granzima B
CL CD 1ª en epidermis
Q y endotelio HLA-DR
Clonalidad LT en 50% de PLEVA
cuña
Vasculitis linfocítica
Dermatitis de interfase
Ig M
C3
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PLEVA PLCr
Papulosis
linfomatoide
Linfoma
anaplásico
CD 30+
CD 30+
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Diagnostico diferencial de PLEVA y PLCr
PLEVA PLCr
Picadura de artrópodos, infestaciones
PRG
Vasculitis leucocitoclásica Erupción medicamentosa
Exantema viral (VVZ- HVS) Psoriasis en gotas
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Siempre investigar !!!
PLEVA PLCr
Papulosis linfomatoidea (CD 30+)
Papulosis linfomatoidea (CD 30+)
Sífilis secundaria Micosis Fungoides
Sífilis secundaria
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Primera línea
Corticoides tópicos
Antibióticos: Eritromicina/Tetraciclinas/Minociclina
Baños de sol
UVB + UVA
UVB banda angosta
Segunda línea
Tacrolimus tópico Prednisona 60/40/20
mg y descenso MTX 10-25 mg/sem PUVA Ciclosporina 2,5-4
mg/k/día Acitretin 25-50mg/día
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Parapsoriasis Micosis Fungoides
Policlonal
Clonal
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Queratosis actínica Nevus displásico Parapsoriasis
Ca espinocelular Melanoma Micosis Fungoides
Estadíos “pre” o in situ
NEOPLASIAS