PANICULITE

Inflamaia esutului gras subcutanat noduli Cauze:

Traumatisme Infecii Boli conjunctiv-vasculare Vasculite

CLASIFICAREA PANICULITELOR
Paniculite predominant septale

Eritem nodos Eritem nodos migrator P. sclerodermic P. cu deficit de 1-antitripsin

Clasificare II - Paniculite lobulare sau mixte

Eritem indurat (TBC) P pancreatic P poststeroidic Lipodermatoscleroza (Insuficienta cronica venoasa P asociate bolilor de tesut conjunctiv (DM, lupic) P lipodistrofice P traumatice P induse infectios P in malignitati P cu necroz grsoas a NN

Paniculita lupica

ERITEMUL NODOS
Definiie Paniculit septal decada 3-4; f/b: 3:1 Etiopatogenie: Infecii Medicamente Sarcoidoz (S Lfgren) Boal Behet Boal inflamatorie cronic intestinal Limfoame, tumori maligne contraceptive, sarcin

Cauze infectioase de eritem nodos

Steptococ Mycoplasma Yersinia Salmonella Mycobacteria Toxoplasma V hepatitic B Borrelia Micoze profunde

Cauze medicamentoase de eritem nodos

Peniciline Sulfonamide Analgezice (paracetamol, ac. Acetilsalicilic, pyrazolone) Contraceptive orale Sruri halogenate

ERITEMUL NODOS
Definiie Paniculit septal decada 3-4; f/b: 3:1 Etiopatogenie: Infecii Medicamente Sarcoidoz (S Lfgren) Boal Behet Boal inflamatorie cronic intestinal Limfoame, tumori maligne contraceptive, sarcin

Eritem nodos
.

 Clinic:

debut infecios aspect evoluie artralgii, febr Diagnostic diferenial: hipodermite nodulare subacute, erizipel, tromboflebite Tratament: AINS

 Tratament:
Antiinflamatorii nesteroidiene: ibuprofen, diclofenac, keroprofen corticosteroizi, iodur de K

Diagnostic diferential

Paniculit cu deficit de 1 antitripsina

Paniculit pancreatic

Paniculit lupic

Eritem indurat (vasculit nodular) etiologie Tbc

VASCULITE
Afectiune inflamatorie a vaselor sanguine Alterarea sau distrucia peretelui vascular Patogenez
Formarea de complexe imune si depunerea lor Autoanticorpi: ANCA, atc anti-celule endoteliale Alterarea funciei celulei endoteliale Granuloame

Structura pielii

VASCULITE
Vasculite ale vaselor mici: - prin complexe imune:vasculite leucocitoclazice Purpura Schonlein-Henoch vasculita urticarian - ANCA-pozitive: Poliangeita microscopic Granulomatoza Wegener Granulomatoza Churg-Strauss Vasculite de vase medii:Poliarterita nodoas Vasculite ale vaselor mari: arterita cu celule gigante Alte vasculite: Boli de colagen asociate cu tumori crioglobulinemice

Vasculite de vase mici

Aspect histopatologic de vasculit de vase mici

Purpur Schonlein-Henoch

-Artralgii -Dureri abdominale -Afectare renal -purpur

 Vasculita leucocitoclazic / vasculit alergic/ tri sau tetra sindrom Gougerot:

Purpur Papule Necroz Ulceraie

Vasculit leucocitoclazic
Etiologie: infecii, medicamente Reacie III Gell i Coombs clinic: purpur, papule, necroz Investigaii: teste cutanate, teste de inflamaie, ex bacteriologic Tratament: corticoterapie, AINS

Reacie de HS tip III

 Vasculit necrotic

Vasculit leucocitoclazic
Etiologie: infecii, medicamente Reacie III Gell i Coombs clinic: purpur, papule, necroz Investigaii: teste cutanate, teste de inflamaie, ex bacteriologic Tratament: corticoterapie, AINS

Urticaria vasculitis
-

consum de complement: C3, C4 scazute Normocomplementemic Leziuni persistente Ex histopatologic: endotelita, infiltrat limfocitar

Vasculita urticariana

Semne de suspiciune in vasculite sistemice

Examinare Semne vitale Cutanate Neurologice Cap i gt Renale Hepatice Modificri Febr, scdere n greutate, HT Purpura palpabil, urticarie, livedo reticular, tromboflebit superf., ulceraii Nervi cutanai palpabili Sinuzit, condrit, otit, irit Sensibilitate loje renale Hepatosplenomegalie

Pulmonare

Raluri

Teste de laborator in vasculite

Sistem Hematologic Renal Hepatic Tehnic Hemo-leucogram Ex urin, uree, creatinin Teste hepatice alterate, atc HBs, HVC, crioglobuline C, FR, AAN. Atc anti-ADN, ENA, ANCA Hemocultur Rx sinus si CT Rx torace si CT ECG, CPK, ecoCD Teste de conducere nervoas

Imunologic F. Infectios Cap i gt Pulmonar Cardiovascular Neurologic

Tratament
Corticosteroizi Dapson Azatioprina ciclofosfamid metotrexat

ERITEMUL POLIMORF
Definiie
Etiologie: - infecii (bacteriene, herpes, hepatit), - medicamente, - limfoame, carcinoame, - colagenoze

Cauze medicamentoase de eritem polimorf

Alopurinol Carbamazepin Cotrimoxazol Lamotrigine Nevirapine Antiinflamatorii nesteroidiene (tip oxicam) Fenobarbital Fenitoin Sulfonamide Aminopeniciline, cefalosporine, macrolide, NSAID, quinolone, tramadol, tetracicline

Forme clinice
- EP minor: Forma papuloas: leziuni n int Forma veziculo- buloas Leziuni mucoase: 25- 60% - EP major / S. Stevens-Johnson: mucoasa bucal, mucoasa ocular, mucoasa genital, manifestari respiratorii

Eritem polimorf

Eritem polimorf form major

.

 EP major

 Evoluie: acut, subacut Diagnostic diferenial:

eczem, dermatoze buloase

Tratament
Tratament topic: Dermocorticoizi Tratament sistemic:
Antiinflamatorii nesteroidiene Corticosteroizi Antibioterapie (infectie bacterian)

Intreruperea medicatiei posibil etiologice