USE OF PHOTOTHERAPY FOR THE TREATMENT OF PYRYASIS LICHENOID CHRONICA, A SAFE THERAPEUTIC OPTION?

• DOI: 10.22533/at.ed.15925122010910

• Palavras-chave: Dermatoses; Phototherapy; Chronic Lichenoid Pityriasis.

• Keywords: Dermatoses; Phototherapy; Chronic Lichenoid Pityriasis.

• Abstract:

  INTRODUCTION: Pityriasis lichenoides (PL) is a papulosquamous disease of unknown cause. It is a rare, self-limiting dermatosis that occurs at any age, especially in children and young adults. It has a benign character and presents an autoimmune response, alternating exacerbations and remissions. Two variants of the disease are described: a mild chronic form, called pityriasis lichenoides chronicis (PLC), and an acute form, also known as pityriasis lichenoides et varioliformis acuta (PLEVA).

  OBJECTIVES: To identify the benefits and harms of using UVA as a therapeutic alternative in PLC, in order to better elucidate the mechanisms that permeate its use.

  METHODOLOGY: The beginning of the study was carried out with theoretical training on the subject, followed by the preparation of a descriptive review of articles available on the “PubMed” and “sciELO” platform, using as descriptors: “Pityriasis lichenoides chronica and PUVA”, including articles published in the last 8 years.

  RESULTS: 7 works were found in the databases described. The pathophysiology of LP is still debatable, with three pathogenic theories being accepted, involving an inflammatory reaction triggered by infectious agents or drugs, T lymphocyte dysplasia and/or vasculitis mediated by immune complexes. LP can present in two acute forms: acute pityriasis lichenoid varioliformis and febrile ulcero-necrotic variant and in a chronic form: PLC. The diagnosis is clinical, and its confirmation is made through histopathological examination. Although the character is benign and self-limiting, treatment is necessary for symptom relief. Many treatment modalities have been reported, but there is no definitive treatment. In this descriptive review, we discuss the use of Psolaren + UVA phototherapy (PUVA) as a therapeutic alternative in PLCA The interaction between PUVA and PLC remains contradictory. Most studies show the therapeutic benefit by improving the clinical and histopathological patterns of the lesions, as well as a faster evolution. On the other hand, other studies have shown that PUVA therapy used in the treatment of other skin conditions increased the incidence of PLC, being similar to classic lesions on histopathological and immunohistochemical bases, indicating a benign nature. Immunogenic studies on susceptibility to this dermatosis have never been performed. In this study, in addition to clinical and laboratory evaluation, we typed HLA class I and II antigens in a series of patients with pityriasis lichenoides.

   

  CONCLUSION: Regardless of the absence of clinical guidelines, PUVA treatment may show benefit in the treatment of PLC, however, additional randomized controlled trials are needed to further assist in clinical decision making.

• Número de páginas: 2