{"id":5962,"date":"2009-01-23T11:28:16","date_gmt":"2009-01-23T15:28:16","guid":{"rendered":"http:\/\/piel-l.org\/blog\/?p=5962"},"modified":"2009-01-24T02:39:29","modified_gmt":"2009-01-24T06:39:29","slug":"consulta-a-un-colega-n4-pitiriasis-rubra-pilar-aguda-como-manejarla","status":"publish","type":"post","link":"https:\/\/piel-l.org\/blog\/5962","title":{"rendered":"Consulta a un Colega N\u00ba4: Pitiriasis Rubra Pilar aguda. Como manejarla."},"content":{"rendered":"<p><em><strong>Enviado por Dres Jaime Piquero Martin y Edgar La  Rotta. Clinica de la piel Clinica Sanatrix Caracas \u2013 Venezuela<\/strong><\/em> <br \/>\n Masculino de 30 a\u00f1os\u00a0 quien consulta por primera vez con placa  eccemetosa circinada en region frontal, la cual luego de examen micol\u00f3gico  directo se concluye que puede corresponder a un eccema seborreico figurado, 10  dias despu\u00e9s retorna con dermatitis seborreica centro facial.<\/p>\n<p><!--more--><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/01\/casos-clinicos-y-fotos-17-01-2009-007.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-5963\" title=\"casos-clinicos-y-fotos-17-01-2009-007\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/01\/casos-clinicos-y-fotos-17-01-2009-007-300x200.jpg\" alt=\"casos-clinicos-y-fotos-17-01-2009-007\" width=\"300\" height=\"200\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2009\/01\/casos-clinicos-y-fotos-17-01-2009-007-300x200.jpg 300w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2009\/01\/casos-clinicos-y-fotos-17-01-2009-007.jpg 640w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><\/p>\n<p><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/01\/casos-clinicos-y-fotos-17-01-2009-008.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-5964\" title=\"casos-clinicos-y-fotos-17-01-2009-008\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/01\/casos-clinicos-y-fotos-17-01-2009-008-300x200.jpg\" alt=\"casos-clinicos-y-fotos-17-01-2009-008\" width=\"300\" height=\"200\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2009\/01\/casos-clinicos-y-fotos-17-01-2009-008-300x200.jpg 300w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2009\/01\/casos-clinicos-y-fotos-17-01-2009-008.jpg 640w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><\/p>\n<p><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/01\/casos-clinicos-y-fotos-17-01-2009-011.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-5965\" title=\"casos-clinicos-y-fotos-17-01-2009-011\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/01\/casos-clinicos-y-fotos-17-01-2009-011-300x200.jpg\" alt=\"casos-clinicos-y-fotos-17-01-2009-011\" width=\"300\" height=\"200\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2009\/01\/casos-clinicos-y-fotos-17-01-2009-011-300x200.jpg 300w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2009\/01\/casos-clinicos-y-fotos-17-01-2009-011.jpg 640w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><\/p>\n<p><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/01\/casos-clinicos-y-fotos-17-01-2009-012.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-5966\" title=\"casos-clinicos-y-fotos-17-01-2009-012\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/01\/casos-clinicos-y-fotos-17-01-2009-012-300x200.jpg\" alt=\"casos-clinicos-y-fotos-17-01-2009-012\" width=\"300\" height=\"200\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2009\/01\/casos-clinicos-y-fotos-17-01-2009-012-300x200.jpg 300w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2009\/01\/casos-clinicos-y-fotos-17-01-2009-012.jpg 640w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><\/p>\n<p><br class=\"spacer_\" \/><\/p>\n<p>Debido al asueto  navide\u00f1o el paciente no puede contactarnos y acude a otro dermat\u00f3logo por  generalizaci\u00f3n del cuadro. \u00c9ste indica Benzetacil y Prednisona a la dosis de 50  mg al d\u00eda, adem\u00e1s de tomar muestra para estudio histopatologico. En el interin  pide una segunda opini\u00f3n a otro dermat\u00f3logo quien le diagnostica Pitiriasis  Rubra Pilar (PRP) y le indica Neotigason 25 mg al d\u00eda la cual el paciente no  toma.<\/p>\n<p>\n El 9\/01\/09 retorna a nosotros y solicitamos la biopsia realizada ( l\u00e1mina)  la cual es compatible con PRP. El paciente se encuentra muy afectado  dermatol\u00f3gica y en forma general incluso emocional. Se toma nueva biopsia por  apreciar en el centro de las placas un esbozo de ampolla o agudizaci\u00f3n de la escamo-costra.  SE comienza a disminuir la Prednisona y se agrega Neotigason a la dosis de 25  mg al dia, adem\u00e1s de emoliencia, Hidroxicina y aplicaci\u00f3n de Calcipotriol +  Betametasona.<\/p>\n<p><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/01\/prp-paraqueratosis-infundibular.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-5971\" title=\"prp-paraqueratosis-infundibular\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/01\/prp-paraqueratosis-infundibular-300x289.jpg\" alt=\"prp-paraqueratosis-infundibular\" width=\"300\" height=\"289\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2009\/01\/prp-paraqueratosis-infundibular-300x289.jpg 300w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2009\/01\/prp-paraqueratosis-infundibular.jpg 724w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><\/p>\n<p><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/01\/prp-3.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-5970\" title=\"prp-3\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/01\/prp-3-274x300.jpg\" alt=\"prp-3\" width=\"274\" height=\"300\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2009\/01\/prp-3-274x300.jpg 274w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2009\/01\/prp-3.jpg 710w\" sizes=\"auto, (max-width: 274px) 100vw, 274px\" \/><\/a><\/p>\n<p><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/01\/prp-2.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-5969\" title=\"prp-2\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/01\/prp-2-300x298.jpg\" alt=\"prp-2\" width=\"300\" height=\"298\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2009\/01\/prp-2-300x298.jpg 300w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2009\/01\/prp-2-150x150.jpg 150w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2009\/01\/prp-2.jpg 806w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><\/p>\n<p><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/01\/prp-1.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-5968\" title=\"prp-1\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/01\/prp-1-300x144.jpg\" alt=\"prp-1\" width=\"300\" height=\"144\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2009\/01\/prp-1-300x144.jpg 300w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2009\/01\/prp-1-1024x493.jpg 1024w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2009\/01\/prp-1.jpg 1512w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><\/p>\n<p><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/01\/dsc06250.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-5967\" title=\"dsc06250\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2009\/01\/dsc06250-300x198.jpg\" alt=\"dsc06250\" width=\"300\" height=\"198\" srcset=\"https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2009\/01\/dsc06250-300x198.jpg 300w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2009\/01\/dsc06250-1024x677.jpg 1024w, https:\/\/piel-l.org\/blog\/wp-content\/uploads\/2009\/01\/dsc06250.jpg 1868w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><\/p>\n<p>El 21\/01\/09 con la nueva biopsia confirmatoria de PRP ya el paciente menos  congestionado pero eritrodermico y examenes paracl\u00ednicos Normales se aumenta la  dosis de Neotigason a 50 Mg al d\u00eda ( el paciente pesa 55 Kg) y se sigue bajando  la dosis de<\/p>\n<p>Prednisona en forma piramidal cada tercer d\u00eda.<\/p>\n<p>\u00bf Que otro manejo sugieren que podamos realizar?<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Enviado por Dres Jaime Piquero Martin y Edgar La Rotta. Clinica de la piel Clinica Sanatrix Caracas \u2013 Venezuela Masculino de 30 a\u00f1os\u00a0 quien consulta por primera vez con placa eccemetosa circinada en region frontal, la cual luego de examen micol\u00f3gico directo se concluye que puede corresponder a un eccema seborreico figurado, 10 dias despu\u00e9s &hellip;<\/p>\n","protected":false},"author":16,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[25],"tags":[],"class_list":["post-5962","post","type-post","status-publish","format-standard","","category-consulte-a-un-colega"],"_links":{"self":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts\/5962","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/users\/16"}],"replies":[{"embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/comments?post=5962"}],"version-history":[{"count":0,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts\/5962\/revisions"}],"wp:attachment":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/media?parent=5962"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/categories?post=5962"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/tags?post=5962"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}