8/7/2019 Curs Lichen Plan

http://slidepdf.com/reader/full/curs-lichen-plan 1/23

LICHEN PLAN

8/7/2019 Curs Lichen Plan

http://slidepdf.com/reader/full/curs-lichen-plan 2/23

Definitie

Afectiune cutaneo-mucoasa, papuloasa,

pruriginoasa, cu evolutie cronica,

autolimitata

8/7/2019 Curs Lichen Plan

http://slidepdf.com/reader/full/curs-lichen-plan 3/23

Epidemiologie

• Prevalenta 0,5-1%

• Apare la orice varsta, mai frecvent

decadele 5-6

• Afecteaza egal ambele sexe

• Uneori poate avea caracter familial

8/7/2019 Curs Lichen Plan

http://slidepdf.com/reader/full/curs-lichen-plan 4/23

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)

8/7/2019 Curs Lichen Plan

http://slidepdf.com/reader/full/curs-lichen-plan 5/23

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

8/7/2019 Curs Lichen Plan

http://slidepdf.com/reader/full/curs-lichen-plan 6/23

Manifestari clinice

• Fen Kobner prezent

• Zone afectate:

 – Reg ant a art pumnului

 – Reg lombara

 – Reg maleolara

 – Gambe

8/7/2019 Curs Lichen Plan

http://slidepdf.com/reader/full/curs-lichen-plan 7/23

8/7/2019 Curs Lichen Plan

http://slidepdf.com/reader/full/curs-lichen-plan 8/23

8/7/2019 Curs Lichen Plan

http://slidepdf.com/reader/full/curs-lichen-plan 9/23

8/7/2019 Curs Lichen Plan

http://slidepdf.com/reader/full/curs-lichen-plan 10/23

8/7/2019 Curs Lichen Plan

http://slidepdf.com/reader/full/curs-lichen-plan 11/23

8/7/2019 Curs Lichen Plan

http://slidepdf.com/reader/full/curs-lichen-plan 12/23

8/7/2019 Curs Lichen Plan

http://slidepdf.com/reader/full/curs-lichen-plan 13/23

8/7/2019 Curs Lichen Plan

http://slidepdf.com/reader/full/curs-lichen-plan 14/23

8/7/2019 Curs Lichen Plan

http://slidepdf.com/reader/full/curs-lichen-plan 15/23

Afectarea unghiala

• La 10% din cazuri

• Subtierea proximala a lamei unghiale

• Pterigium unghial

8/7/2019 Curs Lichen Plan

http://slidepdf.com/reader/full/curs-lichen-plan 16/23

8/7/2019 Curs Lichen Plan

http://slidepdf.com/reader/full/curs-lichen-plan 17/23

Afectarea parului

• Intalnita in LP folicular 

• Determina placi alopecice cicatriciale

8/7/2019 Curs Lichen Plan

http://slidepdf.com/reader/full/curs-lichen-plan 18/23

8/7/2019 Curs Lichen Plan

http://slidepdf.com/reader/full/curs-lichen-plan 19/23

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

8/7/2019 Curs Lichen Plan

http://slidepdf.com/reader/full/curs-lichen-plan 20/23

Histopatologie

• Epiderm:

 – Hipergranuloza focala

 – Acantoza neregulata (“in dinti defierastrau”)

 – Degenerescenta hidropica cel bazale

• Derm – Infiltrat inflamator limfocitar “in banda”

8/7/2019 Curs Lichen Plan

http://slidepdf.com/reader/full/curs-lichen-plan 21/23

8/7/2019 Curs Lichen Plan

http://slidepdf.com/reader/full/curs-lichen-plan 22/23

Prognostic

• Evolutie autolimitata

• Formele mucoase sunt mai recalcitrante

• 15-20% din pacienti pot prezenta

recurente

8/7/2019 Curs Lichen Plan

http://slidepdf.com/reader/full/curs-lichen-plan 23/23

Tratament

• Corticosteroizi (topici si rareori

sistemici)

• Retinoizi

• Fototerapie (PUVA)

• Asociere retinoizi-PUVA (Re-PUVA)

• Ciclosporina