prof. m. pippione
TRANSCRIPT
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Lichen e dermatiti lichenoidi
Prof. M. Pippione
Ospedale Gradenigo – Torino
Casale Monferrato
16-10-2013
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Lichen e dermatiti lichenoidi
• Clinica.
• Dati etiopatogenetici.
• Istologia.
• Altre considerazioni.
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LICHEN RUBER
PLANUS
Dermatite papulosa
benigna che colpisce
la cute e/o le mucose
di soggetti adulti (più
frequentemente tra i
30 e i 40 anni senza
distinzione di sesso),
frequente (prevalenza
dello 0,5%), spesso
cronica e recidivante
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CARATTERISTICHE DELLA PAPULA DEL L.R.P.
• Piccole dimensioni
• Colore rosso-rosa, violaceo (in fase regressiva può assumere un colorito bruno-nerastro dovuto a depositi dermici superficiali di melanina che consente la diagnosi retrospettiva)
• Forma rotondeggiante o poligonale
• Isolate o, per confluenza con le lesioni vicine, formano placche ovalari, dai contorni irregolari, policiclici, o disegnano anelli, strie, arabeschi
• Lucente a luce incidente
• Sommità appiattita o depressa centralmente
• Sedi preferenziali: superficie flessoria dei polsi, avambracci, gambe, regione lombare, genitali, mucosa orale. Può interessare anche unghie e cuoio capelluto
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ALTRE CARATTERISTICHE DEL L.R.P.
• Strie di Wickham: si può distinguere in trasparenza,
sulla superficie delle papule di maggiori dimensioni, un
reticolo formato da strie e punteggiature biancastre
dovuto all’irregolare distribuzione della cheratoialina
• Fenomeno di Koebner: in sede di modesti traumi
compaiono papule a disposizione lineare
• Segno di Bizzozzero: eseguendo sulla lesione un
grattamento metodico la papula si trasforma in una
papulo-vescicola emorragica
• Prurito: quasi sempre presente e particolarmente
intenso nella fase iniziale
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EZIOLOGIA
• La causa del L.R.P. non è stata identificata
• L’ipotesi più accreditata è quella della patogenesi
autoimmune linfocitotossica diretta contro le cellule
basali dell’epidermide
• Il L.R.P. si può associare a patologie
immunologicamente mediate (colite ulcerosa, alopecia
areata, dermatomiosite, ecc.); quella con un’epatopatia
cronica è l’associazione di più frequente riscontro
(soprattutto epatite cronica attiva post-virale HCV)
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= Adesion molecules
= cytotoxic T lymphocytes
MB
MB
Normal epidermis
CYTOTOXIC IMMUNE RESPONSE
= INTERFACE/LICHENOID PATTERN
UV, VIRUSES, Drug aptens,
NOVEL ANTIGENIC PROFILE
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VARIETA’ CLINICHE
• Lichen follicolare
• Lichen verrucoso
• Lichen sclero- atrofico
• Lichen anulare
• Lichen lineare
• Lichen vescico-bulloso
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ASPETTI ISTOPATOLOGICI
Epidermide:
• Ipercheratosi ortocheratosica
• Ipergranulosi
• Acantosi
Derma:
• Infiltrato a banda nel derma
papillare costituito da linfociti
che aggrediscono l’epidermide
e provocano fra epidermide e
derma sottili fissurazioni lineari
contenenti cheratinociti
degenerati (corpi citoidi)
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LICHEN FOLLICOLARE
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LICHEN PLANOPILARIS
• LP that targets
follicles
• Perifollicular
disposition (and
sometimes
subepidermal)
• Perifollicular
fibroplasia
• Scarring alopecia
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LESIONI A PLACCA
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LICHEN VERRUCOSO
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Hypertrophic lichen planus
• Often confined to the
shins
• Severe pruritus
• Verrucous
appearance
• Response to
persistent rubbing
and scratching
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LICHEN SCLERO-ATROFICO
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LICHEN ANULARE
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LICHEN NITIDUS
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LICHEN STRIATUS
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LICHEN PLANUS PEMFIGOIDES
• Association of LP and bullous pemfigoid
• Damage to the basal layer in LP with exposure of BM antigen and consequent formation of circulating antibodies (novel epitope within BP180)
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LICHEN BOLLOSO
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NOTE DI TERAPIA
Locale:
• Corticosteroidi topici o per infiltrazione locale
• Retinoidi
• Tacrolimus allo 0,1% per le forme orali e genitali
Generale:
• Corticosteroidi sistemici
• Acitretina
• Ciclosporina A e retinoidi nelle forme gravi e persistenti
• Antistaminici
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DERMATITI LICHENOIDI
• Reazioni lichenoidi da farmaci
• Eczema papuloso-pitiriasico
• Pitiriasi rosea varietà lichenoide
• Tuberculidi rosaceiformi
• Neurodermite
• Lichen nitidus
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NEURODERMITE
(LICHENIFICAZIONE)
•Manifestazione clinica di frequente
riscontro, determinata dal ripetuto
grattamento
•Placche di forma ovalare a limiti
sfumati, di colorito roseo-grigiastro
•La cute appare ispessita con
evidente accentuazione dei piccoli
solchi cutanei
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LICHEN NITIDUS
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LICHEN PLANUS ACTINICUS
• Melasma-like lesions
(limited to sun-
exposed areas)
• Young, Oriental origin
• Overlap with
erythema
dyscromicum
perstans
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LICHEN PLANUS PIGMENTOSUS
OF THE FOLDS
• Adults
• Large folds of the
body
• Symmetric and
bilateral distribution
• Often large
pigmentary macules
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LICHEN NITIDUS
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LICHEN STRIATUS
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LICHEN PLANUS-LIKE
KERATOSIS
Immunologic response against
solar lentigo
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Thank you for your attention!