Panarteritis nodosa cutánea

La panarteritis nodosa (PAN) es un tipo de vasculitis necrotizante que se clasificahabitualmente en una forma cutanea (c-PAN) y otra sistemica (s-PAN).La primera se caracteriza por presentar un cuadro limitado a la piel, de cursocronico y pronostico benigno. Por el contrario, la forma sistemica cursa consintomas generales, compromiso visceral y es de muy mal pronostico. Ladistincion entre estas dos variantes es aun controvertida: algunos autoressostienen que la forma cutanea seria una variedad abortiva o de comienzo dela forma sistemica, mientras que otros afirman que se trataria de dos entidadesseparadas, sin posibilidad de pasaje de una forma a la otra.Presentamos una paciente de sexo femenino, de 42 anos de edad, queconsulta a nuestro Servicio por presentar nodulos en las piernas, artralgias ymialgias. La biopsia de piel informa panarteritis de arteriolas de dermis profunday tejido celular subcutaneo, compatible con panarteritis nodosa. Sedescarta el compromiso sistemico arribando al diagnostico de PAN cutanea.Se indica tratamiento con prednisona y metotrexato con respuesta variable alo largo de su evolucion... Panarteritis nodosa (PAN) is a necrotizing vasculitis that is classified as a cutaneousform (c-PAN) and a systemic form (s-PAN). The former represents askin-limited disorder that has a benign and chronic course. The latter is a multisystemicdisease with visceral involvement and a severe clinical course. Thedistinction of c-PAN from s-PAN is still controversial: some authors considerthe cutaneous form as an abortive or an initial manifestation of the systemicdisease, while others state that c-PAN is an individual disorder, with no possibilitiesof progressing to s-PAN.We present a 42 year-old female with nodules on the legs, arthralgias andmyalgias. A skin biopsy showed panarteritis affecting arterioles in the deepdermis and superficial sub cutis, as found in polyarteritis nodosa. Systemicinvolvement was ruled out and a c-PAN diagnosis was confirmed. She wasstarted on oral steroids and methotrexate with variable response.We discuss different aspects of this infrequent disease that represents atherapeutic challenge for dermatologists...