Documente Academic
Documente Profesional
Documente Cultură
CLINICAL CASES
Rezumat
Termenul de ,,lupus eritematos (LE) se refer la un
spectru de boli cu evoluie i prognostic variabile. Exist
trei forme majore de LE precum: lupus eritematos cutanat
cronic, lupus eritematos cutanat subacut (LECS) i lupus
eritematos sistemic.(1) LECS implic, n primul rnd,
epidermul i dermul superior i este asociat cu anticorpi
anti-Ro/SSA i fotosensibilitate; majoritatea pacienilor nu
au afectare sistemic semnificativ.(2) Lichenul plan (LP)
este o boal idiopatic inflamatorie a pielii, prului,
unghiilor i mucoaselor ce afecteaz, n general, adulii de
vrst medie.(13) Hepatita cu virus C (HVC) reprezint o
problem major de sntate public, fiind principala cauz
a bolilor hepatice cronice, a cirozei si a carcinomului
hepatocelular. n ultimii ani, a devenit cunoscut c VHC
induce un spectru larg de manifestri extrahepatice,
inclusiv manifestri cutanate, precum LP.(15)
Prezena LP cutanat i a LP oral poate fi utilizat ca
marker al infeciei cu VHC la pacienii asimptomatici, ceea
ce poate duce la un diagnostic corect, un tratament precoce
i, eventual, un prognostic mai bun al infeciei cu VHC.
Sindromul de suprapunere LE/LP este o afeciune rar ce
combin aspecte clinice, histologice i imunopatologice att
*
**
Summary
The term ,,Lupus erythematosus (LE) refers to a
spectrum of diseases that vary in their course and
prognosis. The three major forms of LE are: chronic
cutaneous lupus erythematosus, subacute cutaneous lupus
erythematosus (SCLE) and systemic lupus erythematosus.
(1) SCLE involves primarily the epidermis and upper
dermis and is associated with anti-Ro/SSA autoantibodies
and photosensitivity; the majority of patients do not have
significant systemic disesase. (2) Lichen planus (LP) is an
idiopathic inflammatory disease of the skin, hair, nails and
mucous membranes, seen most commonly in middle-aged
adults. (13) Hepatitis C virus (HCV) represents a major
public health problem as a causative agent in developing
chronic hepatitis, cirrhosis, and hepatocellular carcinoma.
In recent years it has become known that HCV induces a
broad spectrum of extrahepatic manifestations, including
some cutaneous ones such as LP. (15) The presence of
cutaneous LP and oral lichen planus can potentially be
used as a marker of HCV infection in asymptomatic
patients, leading to proper diagnosis and early treatment
and, possibly, a better prognosis of chronic hepatitis C.
Lupus erythematosus/lichen planus overlap syndrome is a
263
264
265
266
2. SUBACUTE CUTANEOUS
LUPUS ERYTHEMATOSUS (SCLE)
Definition:
SCLE is an intermediary form of lupus
erythematosus (LE) between discoid lupus
erythematosus (DLE) and systemic lupus
erythematosus (SLE).1
Subacute cutaneous lupus involves primarily
the epidermis and the upper dermis and is
associated with anti-Ro/SSA antibodies,
arthralgia and photosensitivity. Most patients do
not present significant systemic disorders.2
Epidemiology:
SCLE is less common than DLE or SLE. It is
predominant in females, and the onset age
usually ranges from 30 to 40 years. The disease
can also appear after the age of 60, especially
medication-induced.
Clinical aspects:
SCLE is initially characterised by erythematosus patches and/or papules that turn to
psoriasi form papulosquamous lesions or
annular/polycyclic plaques. Some patients can
develop elements of both morphological forms.
SCLE lesions occur mainly on sun-exposed areas
(e.g. upper part of posterior thorax, shoulders,
arms, V neckline and, less common, on the face).
They usually heal with residual hypopigmentation or depigmentation, without
scarring and without follicular hyperkeratosis
(main characteristics distinguishing it from
chronic cutaneous lupus erythematosus). Lesions
are not indurated as they are characterised by
superficial and rare inflammatory infiltrate.
Histopathology:
Modifications are less evident than in DLE.
The epidermis shows minimal atrophy and
vacuolar modifications and the dermis shows
rare lymphocytic inflammatory infiltrate.
Laboratory tests:
Anti-Ro antibodies, which are characteristic for
this form of lupus, are present at a rate of 60%-90%.
Antinuclear antibodies (ANA) are positive in 60%80% of patients, in 40% of patients anti-
267
268
269
Limfom malign
Glomerulonefrit membranoproliferativ
Tiroidit cronic
Lichen plan
Diabet zaharat
Sindrom Sjgren
Pneumonie interstiial
Miozit
Cancer oral
Miocardiopatie
Cryoglobulinemia
Malignant lymphoma
Glomerulonephritis membranoproliferative
Chronic thyroiditis
Lichen planus
Diabetes
Sjgrens syndrome
Interstitial pneumonia
Myositis
Oral cancer
Cardiomyopathy
270
271
272
273
274
Bibliografie/Bibliography
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
275
Conflict de interese
NEDECLARATE
Adresa de coresponden:
Correspondance address:
Conflict of interest
NONE DECLARED