ABSTRACT
La pitiriasis liquenoide crónica (PLC) es una enfermedad benigna, que se caracteriza por tener un curso gradual, con aparición de múltiples pápulas con escamas adherentes de predominio en tronco y extremidades proximales. Con el objetivo de describir la presentación clínica, discutir el diagnóstico, diagnósticos diferenciales, tratamiento y revisar la literatura se presenta el caso de un hombre de 88 años que presentó múltiples lesiones papuloescamosas en extremidades inferiores. Se realizó biopsia cutánea que confirmó el diagnóstico de PLC. El paciente recibió tratamiento con emulsión hidratante, clobetasol tópico y claritromicina con resolución completa de las lesiones. La pitiriasis liquenoide crónica es un trastorno inflamatorio poco frecuente, de etiología desconocida que ocurre más comúnmente en adultos jóvenes y niños. Si bien la clínica es sugerente, se requiere biopsia cutánea para su confirmación diagnóstica. Es un trastorno benigno, a menudo asintomático y autolimitado, por lo que se debe valorar su tratamiento paciente a paciente. Principalmente se utilizan corticoides tópicos y antibióticos orales (tetraciclinas y eritromicina). Se ha vinculado en escasas publicaciones con el desarrollo de linfoma cutáneo y como síndromes paraneoplásicos, por lo que se sugiere realizar seguimiento.
Chronic lichenoid pityriasis (PLC) is a benign disorder, characterized by a gradual course with the appearance of multiple squamous papules with adherent scales predominating in the trunk and proximal extremities. With the objective to describe its clinical presentation, diagnosis, differential diagnosis, treatment and review literature, we present an 88-yearold male with multiple lesions in the lower extremities of one year of evolution, with papules and adherent scales. A skin biopsy was performed that confirmed the diagnosis of PLC. The patient received treatment with moisturizing emulsion, clobetasol topical and clarithromycin with complete resolution of the lesions. Chronic lichenoid pityriasis is a rare inflammatory disease of unknown etiology that occurs most commonly in young adults and children. Although the clinic is suggestive, a skin biopsy is required for diagnostic confirmation. It is a benign disorder, often asymptomatic and self-limiting, so its patientto- patient treatment should be assessed. Topical corticosteroids and oral antibiotics (tetracyclines and erythromycin) are used. It has been linked in few publications with the development of cutaneous lymphoma and as paraneoplastic syndromes, so it is suggested to follow up.
Subject(s)
Humans , Male , Aged, 80 and over , Pityriasis Lichenoides/diagnosis , Pityriasis Lichenoides/pathology , Biopsy , Clobetasol/administration & dosage , Chronic Disease , Treatment Outcome , Pityriasis Lichenoides/drug therapy , Clarithromycin/administration & dosage , Anti-Inflammatory Agents/administration & dosage , Anti-Bacterial Agents/administration & dosageABSTRACT
Herein, we present three cases of Pityriasis lichenoides chronica (PLC) in patients who developed the rash after use of 3-hydroxy-3-methyl-glutaryl-Coenzyme A (HMG-CoA) reductase inhibitors. The patients had complete resolution after standard treatment by dermatologists and withdrawal of the offending agents. In one case, the patient had a previous episode of a similar rash that occurred with HMG-CoA reductase inhibitors use many years previously. Pityriasis lichenoides chronica is a condition of unknown aetiology. Several agents have been associated with its presentation. We postulate HMG-CoA reductase inhibition in skin presents a final common pathway for the presentation of PLC in select patients.
Se presentan tres casos de pitiriasis liquenoide crónica (PLC) en pacientes que desarrollaron una erupción tras el uso de inhibidores de la reductasa de la hidroxi-metilglutaril-coenzima A (HMG-CoA). Los pacientes tuvieron resolución completa después del tratamiento estándar dado por los dermatólogos, y la suspensión de los agentes ofensivos. En un caso, el paciente tuvo un episodio de una erupción similar anterior, que ocurrió debido al uso de inhibidores de la reductasa de HMG-CoA muchos años atrás. La pitiriasis liquenoide crónica es una condición de etiología desconocida. Varios agentes han sido asociados con su manifestación. Se postula que la inhibición de la reductasa de HMG-CoA presenta un camino final común para la manifestación de PLC en determinados pacientes.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects , Pityriasis Lichenoides/chemically induced , Drug Eruptions/etiologyABSTRACT
A clinicopathological study of 12 cases of pityriasis lichenoides chronica and 14 cases of small plaque parapsoriasis was performed. Patients with pityriasis lichenoides chranica ranged in age from 15 to 62 years (mean, 30 years) with male predominance. They had erythematous or reddish scaly papules occuring mostly on both trunk and extremities(92%). The lesions were about the size of r ice grains or small peas. Patients with small plaque parapsoriasis ranged in age from 8 to 67 years(mean, 33 years) and presented yellowish or erythematous scaly maculies and patches comrnonly involving the trunk and extremities(64%). The size of the lesions were larger than those of pityriasis lichenoides chronica. Histopatbologically, the distinct feature of pityriasis lichenoides chronica was vacuolar alteration at the dermoepidermal junction characterizing interface dermatitis. The microscopic findings of small plaque parapsoriasis were, although not as distinct as in pityriasis lichenoides chronica, those af either spongiotic dermatitis or superfirial peri vascula dermatitis. We conclude from this study that these two conditions have different clinical and histologic features and we propose that the term guttate parapsoriasis shauld not be used as a synonym of either pityriasis lichenoides rhronica or small plaque parapsoriasis.