Dermatitis liquenoides
Transcript of Dermatitis liquenoides
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Maite Fernández Figueras
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TTéérmino clrmino clííniconico
LiquenoideLiquenoide
Similar a un liquen por su silueta
poligonal y su aspecto rugoso
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�� LiquenLiquen simple crónico (eczema)
�� Liquen Liquen aureus (vasculitis)
�� LiquenLiquen escleroatrófico (esclerosis)
�� LiquenLiquen amiloide (depósito)
�� LiquenLiquen escrofuloso (tubercúlide)
� Etc…
¡¡No todos los No todos los ““llííquenesquenes”” son liquenoides!son liquenoides!
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TerminologTerminologíía confusaa confusa
� Dermatitis liquenoide
� Dermatitis vacuolar
� Dermatitis de interfase
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Apoptosis queratinocitariaApoptosis queratinocitaria
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DegeneraciDegeneracióón vacuolar de la basaln vacuolar de la basal
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Basal
Nodular
Basal y perivascular
Infiltrado linfoide Infiltrado linfoide
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Dermatitis liquenoideDermatitis liquenoide
� Pura
� Asociada a otros patrones
� Simulada por otros procesos
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Liquen planoLiquen plano
� Córnea Hiperqueratosis ortoqueratósica
� Epidermis Silueta dentada con hipergranulosisDaño vacuolar basal y apoptosis
� Linfocitos Infiltrado en banda (± perianexial)
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Liquen plano ampollosoLiquen plano ampollosoEspacios de CaspariEspacios de Caspari--JosephJoseph
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Liquen plano en fase crLiquen plano en fase cróónica (atròfico) nica (atròfico)
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Liquen plano hipertrLiquen plano hipertróóficofico
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Liquen plano hipertrLiquen plano hipertróóficofico
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Liquen plano en mucosasLiquen plano en mucosas
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Liquen plano pilarLiquen plano pilar
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Sd. Lassueur-Graham-Little-Piccardi
1. Alopecia cicatrizal
2. Alopecia no cicatrizal en axilas e ingles
3. Pápulas foliculares (liquen plano folicular)
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Liquen plano unguealLiquen plano ungueal
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Variantes solitarias Variantes solitarias
(puramente cl(puramente clíínicas)nicas)
� Lineal
� Anular
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Lesiones con clLesiones con clíínica nica caractercaracteríísticastica
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Eritema multiformeEritema multiforme
� Apoptosis basal y
suprabasal
� Edema en dermis
papilar
� Infiltrado linfoide
basal y perivascular
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Eritema multiformeEritema multiforme
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Sd RowellSd Rowell (Lupus eritematoso simulando EM)(Lupus eritematoso simulando EM)
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� Apoptosis masiva
� Mínima celularidad
inflamatoria
Sd. Stevens Johnson/NecrSd. Stevens Johnson/Necróólisis epidlisis epidéérmica trmica tóóxica xica
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Enfermedad injerto contra huespedEnfermedad injerto contra huesped
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GradoGrado 00 Piel normal
GradoGrado 1 1 Solo vacuolización basal
Grado Grado 22 + Apoptosis con linfocitos satélite
y melanófagos
Grado Grado 3 3 + Hendiduras y microvesículas
Grado Grado 44 + Necrosis masiva con denudación
epidèrmica
EICH: GraduaciEICH: Graduacióón n
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Liquen nitidoLiquen nitido
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� Dermatitis liquenoide severa � Oral y genital
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IgG
PPéénfigo paraneoplnfigo paraneopláásicosico
IgG
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Eritema doloroso en palmas y plantas tras tratamiento quimioterápico
Eritema acralEritema acral
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Erupción fija
pigmentariapigmentaria
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ErupciErupcióón fija pigmentarian fija pigmentaria
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Lesiones liquenoides solitariasLesiones liquenoides solitarias
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““Queratosis liquen planoQueratosis liquen plano--likelike””
� Placas de 3-10 mm
� Rosada, violácea, levemente
descamativa o ulcerada
� Zona pre-esternal o brazos
� Mujeres +++
� Edad media o avanzada
� Aparición rápida, leve prurito
� Dx clínico BCC superf. o Bowen
Queratosis liquenoide benignaQueratosis liquenoide benigna
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Queratosis liquenoide benignaQueratosis liquenoide benigna
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Queratosis liquenoide benignaQueratosis liquenoide benigna
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Queratosis liquenoide benignaQueratosis liquenoide benigna
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Queratosis actQueratosis actíínica liquenoidenica liquenoide
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Queratosis actQueratosis actíínica liquenoidenica liquenoide
QLBQLB
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Melanoma in situ liquenoideMelanoma in situ liquenoide
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Lesiones liquenoides Lesiones liquenoides en en ááreas grandesreas grandes
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Morfea en fase inicial Morfea en fase inicial
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MorfeaMorfea
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Liquen escleroatrLiquen escleroatróóficofico
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Micosis fungoideMicosis fungoide
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FototoxiaFototoxia
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SSíífilisfilis
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PPéérezrez--PPéérez. Actas Dermosifiliogr. 2007rez. Actas Dermosifiliogr. 2007
SSíífilis malignafilis malignaÚlceronecrótica con
daño vascular
Kelly, BMJ 2011Kelly, BMJ 2011
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Lesiones liquenoides combinadasLesiones liquenoides combinadas
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� Edad media 4 años, niñas 2:1
� Extremidades (lineas de Blaschko)
� Autolimitado (6 meses)
� Estaciones frias y atopia
Pediatr Dermatol 2004;21:197-204
Liquen estriadoLiquen estriado
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Liquen estriadoLiquen estriado
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Liquen estriadoLiquen estriado
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� Combinación de
patrones
� Eosinofilia
� Céls. plamáticas
� Edema en dermis
papilar
ErupciErupcióón liquenoide por fn liquenoide por fáármacosrmacos
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Pitiriasis liquenoide crPitiriasis liquenoide cróónicanica
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Patrones:
� Liquenoide
� Psoriasiforme
� Espongiotico
� Vasculítico
Pitiriasis liquenoide crPitiriasis liquenoide cróónicanica
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Pitiriasis liquenoide crPitiriasis liquenoide cróónicanica
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Pitiriasis liquenoide aguda (PLEVA)Pitiriasis liquenoide aguda (PLEVA)
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�Placa pretibial elongada de larga evolución en niños
�Picadura de insecto? APACHE?
HistopatologHistopatologíía: a:
�Infiltrado linfoplasmocitario
�Dermatitis liquenoide
�Granulomas
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PPúúrpura pigmentaria liquenoide (Gougerot Blum)rpura pigmentaria liquenoide (Gougerot Blum)Micosis fungoides tres aMicosis fungoides tres añños mos máás tardes tarde
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Perniosis ecuestrePerniosis ecuestre
Daño liquenoide
Vasculitis linfocitariaEdema en dermis papilar
Perniosis Perniosis
Idiopática: IL periecrino
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Dermatitis liquenoideDermatitis liquenoide
� Prototipo: liquen plano
� Hipertròfico
� Atrófico (crónico)
� Ampolloso
� Localizado (pilar, ungueal, mucoso)
� Solitario (anular, lineal)
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Dermatitis liquenoideDermatitis liquenoide
� Clinicamente característica:
� Lineal: liquen estriado (“camaleon”)
� Micropápulas: liquen nítido (“cangrejo”)
� En diana: Eritema multiforme
� Postrasplante: EICH
� Pretibial: Placa linfoplasmocitaria
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Dermatitis liquenoideDermatitis liquenoide
� Grave:
�Diseminada: TEN, Steven Johnson
�Inicio oral y genital: Pénfigo paraneoplásico
�Con vasculitis necrotizante: Sífilis maligna
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Dermatitis liquenoideDermatitis liquenoide
� Combinada con otros patrones
� Sífilis (psoriasis, granulomas, vasculitis, etc)
� Liquen estriado (IL periecrino!)
� Toxicodermia, E fija pigm (eosinófilia y otros)
� Pitiriasis liquenoide (psoriasis, vascular)
� Perniosis (vasculitis)
� Vasculitis linfocitaria: Púrpura pigmentaria
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Dermatitis liquenoideDermatitis liquenoide
� Simuladores
� Queratosis liquenoide benigna
� Queratosis actinica liquenoide
� Morfea inicial/LEA
� Micosis fungoide
� Melanoma
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Masia Freixa, TerrassaMasia Freixa, Terrassa