Lúpus Eritematoso: Manifestações Cutâneas e Tratamento
Resumo
Lúpus eritematoso cutâneo engloba um vasto leque de manifestações dermatológicas, que podem ou não acompanhar- se de acometimento sistémico. As lesões cutâneas específicas – definidas histologicamente pela presença de dermatite de interface – são ainda dividas em subtipos, concretamente lúpus agudo, subagudo ou crónico. O subtipo crónico inclui ainda o lúpus discóide, bem como variantes mais raras, como o lúpus profundo. As manifestações cutâneas não específicas, nomeadamente o livedo reticular ou purpura, são mais frequentes nos doentes com acometimento sistémico. A abordagem diagnóstica implica a correcta subclassificação do subtipo, através duma combinação de exame físico, estudo laboratorial, análise histológica e ocasionalmente imunofluorescência directa, sendo imperativo a exclusão de atingimento sistémico. Do ponto de vista terapêutico, os corticosteróides tópicos e antimaláricos permanecem como a base da terapêutica; no entanto, imunossupressores, análogos da talidomida e anticorpos monoclonais são terapias sistémicas disponíveis para o tratamento da doença recalcitrante. A educação do doente acerca de medidas de fotoproteção e evicção de factores despoletantes é fulcral.
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