What is lichen planus? Causes, symptoms and treatment. Deprive a person. Symptoms, signs and treatment. What does deprive look like. Photos, views, stages with names

Lichen planus (LP) is a chronic inflammatory disease of the skin and mucous membranes, rarely affecting the nails and hair, the typical elements of which are papules.

Etiology and epidemiology

The etiology of the disease is unknown. LP is considered as an autoimmune disease, in which the expression of a hitherto unidentified antigen by keratinocytes of the basal layer leads to the activation and migration of T-lymphocytes into the skin with the formation of an immune response and an inflammatory reaction. An association of LP with viral hepatitis C is suspected, but convincing data confirming this association has not been received.

LP is most common in people between the ages of 30 and 60. Women account for 60–75% of patients with LP with lesions of the oral mucosa and about 50% of patients with LP with skin lesions.

LP is rare in children, with only 5% of cases occurring in pediatric patients.

Lichen planus classification

• L43.0 Lichen hypertrophic red flat
• L43.1 Lichen red flat bullous
• L43.2 Lichenoid drug reaction
• If necessary, to identify the medicinal product, use an additional external cause code (class XX).
• L43.3 Lichen planus, subacute (active)
• Lichen red flat tropical
• L43.8 Lichen planus other

Symptoms of lichen planus

LP is characterized by a different clinical picture of lesions of the skin and mucous membranes, among which the most clinically significant is the lesion of the oral mucosa, although with LP, rashes can also be observed on the mucous membranes of the esophagus and anogenital region. The most common forms of skin lesions in LP are:

• Typical.
• Hypertrophic, or verrucous.
• Atrophic.
• pigmented.
• Bubble.
• Erosive and ulcerative.
• Follicular.

There are 6 forms of lesions of the oral mucosa and the red border of the lips in LP.

• Typical.
• Hyperkeratotic.
• Exudative-hyperemic.
• Erosive and ulcerative.
• bullous.
• Atypical.

Skin lesions in LP

The skin lesion in a typical form of lichen planus is characterized by flat papules 2–5 mm in diameter, with polygonal outlines, with an depression in the center, pinkish-red in color with a characteristic purple or lilac tint and a waxy sheen, more distinct in side lighting. Peeling is usually insignificant, scales are separated with difficulty. On the surface of larger nodules, especially after oiling, a reticular pattern (Wickham's mesh symptom) can be found.

A characteristic feature of lichen planus is a tendency to a grouped arrangement of rashes with the formation of rings, garlands, lines. Less commonly, the nodules merge, forming plaques with a shagreen surface. Around the plaques, new papules may appear, located more or less densely. In most cases, the rash is localized symmetrically on the flexor surfaces of the limbs, trunk, genitals, and quite often on the oral mucosa. Rarely affected palms, soles, face. Subjectively, patients are concerned about itching. During the exacerbation of LP, a positive Koebner phenomenon is observed - the appearance of new nodules at the site of skin trauma.

The hypertrophic form of LP is characterized by the formation of round or oval plaques, 4–7 cm in diameter or more. The color of the plaques is liquid with a purple tint. The surface of the plaques is uneven, bumpy, dotted with warty protrusions with many depressions. On the periphery of the main lesions, small purple-reddish nodules can be detected, characteristic of a typical form of LP.

hypertrophic form

The atrophic form of LP is characterized by the outcome of eruptive elements in atrophy. Skin lesions are most often observed on the head, trunk, armpits and genitals. Rashes are not numerous, they consist of typical nodules and atrophic spots with a lilac and yellowish-brown color. When they merge, bluish-brown atrophic plaques are formed, ranging in size from 1 to 2–3 cm.

atrophic form

The pigmented form of LP occurs acutely, affects a significant surface of the skin (torso, face, limbs) and is characterized by multiple brown spotted rashes that merge into diffuse lesions. At the same time, it is possible to detect both nodules characteristic of the typical form of LP and pigmented elements. Pigmentation of the skin can be combined with characteristic LP lesions on the oral mucosa.

pigmented form

The bullous form of LP is clinically characterized by the formation of vesicles or blisters on plaques and papules on erythematous areas or intact skin. Rashes have a different size, a thick tense tire, which later becomes flabby, wrinkled. The contents of the blisters are transparent, slightly opalescent with a yellowish tinge, in some places - with an admixture of blood.

bullous form

In the erosive-ulcerative form of LP, erosions are observed on the skin and mucous membranes, often with scalloped edges, ranging in size from 1 to 4–5 cm or more. Ulcerative lesions are rare, localized on the lower extremities and accompanied by pain, aggravated by walking. The edges of the ulcers are dense, pinkish-bluish in color, rise above the level of the surrounding healthy skin. The bottom of the ulcers is covered with sluggish granular granulations with necrotic plaque.

erosive-ulcerative form

The follicular form of LP is characterized by the appearance mainly on the skin of the trunk and inner surfaces of the extremities of follicular pointed papules covered with dense horny spines. The combination of follicular LP, scarring alopecia on the scalp, and non-scarring alopecia in the armpits and pubis is known as Graham-Little-Lassueur syndrome.

follicular form

The course of LP with skin lesions is usually favorable. Spontaneous remissions of skin lesions in LP within 1 year after onset are observed in 64–68% of patients.

Damage to the oral mucosa in LP

Changes in the oral mucosa in LP are most often localized in the cheeks, tongue, lips, less often in the gums, palate, and bottom of the mouth.

The typical form of LP of the oral mucosa is characterized by small grayish-white papules up to 2–3 mm in diameter. Papules can merge with each other, forming a grid, lines, arcs, a fancy lace pattern. Plaques with sharp borders may appear, protruding above the surrounding mucosa and resembling leukoplakia. Subjective sensations in the typical form of LP of the oral mucosa are usually absent.

typical shape

The hyperkeratotic form of LP is characterized by the appearance of solid cornification foci with sharp boundaries against the background of typical rashes or the appearance of verrucous growths on the surface of the plaques. Patients may report dry mouth and mild pain when eating hot food.

Hyperkeratotic form

The exudative-hyperemic form of LP of the oral mucosa is distinguished by the location of typical grayish-white papules on the hyperemic and edematous mucosa. Eating, especially hot and spicy, is accompanied by soreness.

Exudative-hyperemic form

The erosive-ulcerative form of LP of the oral mucosa is characterized by the presence of small single or multiple, occupying a large area of ​​erosion, less often - ulcers, irregular outlines, covered with fibrous plaque, after removal of which bleeding is observed. The erosive-ulcerative form of LP is characterized by a long existence of erosions and ulcers that have arisen, around which papules typical of LP can be located on a hyperemic and edematous base.

Erosive and ulcerative form

The bullous form of LP of the oral mucosa is characterized by the simultaneous presence of typical papular rashes and whitish-pearl blisters up to 1–2 cm in diameter. Bubbles have a dense tire and can exist from several hours to 2 days. After the opening of the blisters, rapidly epithelializing erosions are formed.

bullous form

The atypical form of LP of the oral mucosa is a lesion of the mucous membrane of the upper lip in the form of symmetrically located foci of limited congestive hyperemia, protruding above the surrounding mucosa. The upper lip is swollen.

LP of the oral mucosa is considered as a potentially precancerous condition with the possibility of developing squamous cell carcinoma. Cases of the development of squamous cell carcinoma in chronic foci of LP in the anogenital region, the esophagus, with hypertrophic LP are described.

Spontaneous remissions of LP of the oral mucosa are observed in 2.8–6.5% of patients, which is much less common than with skin lesions. The average duration of the existence of rashes on the oral mucosa in LP is about 5 years, however, the erosive form of the disease is not prone to spontaneous resolution. A typical form of the disease with reticular lesions on the oral mucosa has a better prognosis, since spontaneous remission occurs in 40% of cases.

Diagnosis of lichen planus

In most cases, the diagnosis of LP is based on clinical findings. However, if the patient has hypertrophic, atrophic, pigmented, cystic, erosive-ulcerative and follicular forms, typical elements of LP that allow clinical diagnosis may be absent. To clarify the diagnosis, a histological examination of skin biopsies from the most characteristic lesions is carried out.
Histological examination of the skin biopsy with LP reveals hyperkeratosis with uneven granulosis, acanthosis, vacuolar dystrophy of the cells of the basal layer of the epidermis, a diffuse band-like infiltrate in the upper dermis, closely adjacent to the epidermis, the lower border of which is "blurred" by the cells of the infiltrate. Exocytosis is noted. In the deeper parts of the dermis, dilated vessels and perivascular infiltrates are visible, consisting mainly of lymphocytes, among which are histiocytes, tissue basophils and melanophages. In long-term foci, infiltrates are denser and consist mainly of histiocytes. On the border between the epidermis and the dermis, Civatt bodies (colloidal bodies) are localized - degenerated keratinocytes.

Direct immunofluorescence reaction can be used for diagnosis in bullous and erosive-ulcerative forms of LP. In the study by direct immunofluorescence at the border between the epidermis and dermis, abundant accumulations of fibrin are detected, in Civatt's bodies - IgM, less often - IgA, IgG and the compliment component.

In the case of an isolated erosive and ulcerative lesion of the oral mucosa, a cytological study may be required for the purpose of differential diagnosis with true acantholytic pemphigus, in which, unlike LP, acantholytic cells are found in the lesions.

Before prescribing systemic drug therapy or when deciding on further treatment tactics, it is necessary to conduct laboratory tests:

• clinical blood test;
• biochemical blood test (ALT, AST, total bilirubin, triglycerides, cholesterol, total protein);
• clinical analysis of urine.

According to indications consultations of other experts are appointed.

• before the appointment of PUVA therapy, narrow-band medium-wavelength phototherapy - consultations of an oculist, endocrinologist, therapist, gynecologist to exclude contraindications;
• before prescribing antimalarial drugs to exclude contraindications, as well as during therapy with antimalarial drugs, it is recommended to consult an ophthalmologist once every 1.5–3 months to monitor the function of the organ of vision;
• To determine the nature of an isolated lesion of the oral mucosa, a consultation with a dentist may be recommended.

Differential Diagnosis

The differential diagnosis of LP is carried out with secondary syphilis, atopic dermatitis, pityriasis rubra pilaris, Darier's disease, psoriasis.

With syphilis, papular elements are oval or rounded, flaky with the formation of Biett's collar, rarely accompanied by itching. At the same time, the surface of the papules is hemispherical, and not flattened, and does not have a central depression. Other manifestations of syphilis and the results of specific serological reactions are also taken into account. Unlike papular syphilides, nodules with lichen planus are reddish-purple in color, located more superficially and less infiltrated, and have polygonal outlines.

papular syphilis

In atopic dermatitis, mucosal lesions are not observed, as in LP. Rashes in atopic dermatitis are usually located in the elbow and popliteal folds, on the face. For atopic dermatitis, lichenification of lesions is also more characteristic.

atopic dermatitis

With pityriasis versicolor pilaris (Devergy's disease), the rash consists of yellowish-red follicular papules and is more often localized on the extensor surface of the extremities, especially on the dorsum of the fingers (Besnier's symptom). There is a tendency for papules to merge with the formation of foci with a rough surface resembling a grater, exfoliative erythroderma sometimes develops, keratoses occur in the area of ​​​​the palms and soles, which is uncharacteristic for KLP.

Devergie's disease

Darier's follicular dyskeratosis (Darier's disease), in contrast to LP, is characterized by papules with a diameter of 2–5 mm, grayish or brownish in color, covered with hard keratinized crusts, tightly adjacent to their surface. Rashes are usually located symmetrically on the scalp, face, neck, sternum, between the shoulder blades, in the axillary and inguinal-femoral folds.

Darier disease

In psoriasis, the primary morphological element is pinkish-red or deep red papules, covered with a large number of loose silvery-whitish scales, which, when scraped, reveal a positive psoriatic triad of symptoms: stearin stain, “terminal film” and pinpoint bleeding.

psoriasis

Treatment of lichen planus

Treatment Goals

• regression of rashes;
• improving the quality of life of patients.

General notes on therapy

The choice of treatment method for LP depends on the severity and localization of clinical manifestations, the form and duration of the disease, and information about the effectiveness of previous therapy.

Treatment is not required for lesions of the oral mucosa, limited to reticular rashes of a typical form of LP, not accompanied by subjective sensations. In other cases, patients with LP require therapy.

During the period of exacerbation of the disease, patients are recommended a sparing regimen with limitation of physical and psycho-emotional stress. In the food regimen, salty, smoked, fried foods should be limited. In patients with lesions of the oral mucosa, it is necessary to exclude irritating and coarse food.

Indications for hospitalization

• failure of outpatient treatment;
• widespread and severe lesions of the skin and mucous membranes, including hyperkeratotic, bullous, erosive and ulcerative.

Treatment regimens for lichen planus:

Medical treatment

External Therapy

In the presence of limited rashes, treatment begins with the appointment of topical glucocorticosteroid drugs of medium and high activity (their alternation is possible):

• betamethasone, cream, ointment
• clobetasol, cream, ointment
• hydrocortisone-17 butyrate, cream, ointment
• triamcinolone ointment
• mometasone, cream, ointment, lotion
• betamethasone + salicylic acid, ointment
• salicylic acid + flumethasone, ointment

Systemic therapy

Glucocorticosteroid preparations of systemic action.

• prednisolone 20–30 mg
• betamethasone 1 ml
• In the treatment of patients with lichen planus, antimalarial drugs can be used, which are used as systemic therapy and can be prescribed with glucocorticosteroid drugs.
• Hydroxychloroquine 200 mg
• chloroquine 250 mg

To relieve itching, one of the 1st generation antihistamines is prescribed, which is used both orally and in injectable forms.

• mebhydrolin (D) 100 mg
• clemastine (D) 1 mg

Also, in order to reduce itching, an antipsychotic with H 1 -blocking activity can be prescribed: hydroxyzine 25-100 mg

Non-drug treatment

• With a slight infiltration of lesions, narrow-band medium-wave phototherapy with a wavelength of 311 nm is prescribed
• Patients with more pronounced infiltration in the lesions are indicated for PUVA therapy with oral or external use of a photosensitizer:
• PUVA therapy with oral photosensitizers: methoxsalen 0.6 mg per kg of body weight
• PUVA therapy with external use of photosensitizers: methoxsalen 0.5–1 mg/l,

Treatment of LP of the oral mucosa

The first-line drugs for the treatment of patients with LP of the oral mucosa are topical glucocorticosteroid drugs:

• betamethasone, cream, ointment
• triamcinolone ointment
• fluocinolone acetonide, cream, gel, ointment
• clobetasol, cream, ointment

In case of ineffectiveness of topical corticosteroid preparations, topical retinoids are prescribed:

• isotretinoin gel

Additionally, painkillers and wound healing agents are used:

• aloe arborescens leaves, liniment
• lidocaine + chamomile flower extract, gel
• choline salicylate + cetalkonium chloride, dental gel

In the case of severe LP of the oral mucosa, resistant to ongoing therapy, systemic glucocorticosteroid drugs are used:

• prednisolone 0.5–1 mg per kg of body weight

Special situations

For the treatment of children, topical glucocorticosteroid drugs are used.

Tactics in the absence of the effect of treatment

Patients with LP may be given acitretin or cyclosporine if therapy fails.

• acitretin 30 mg daily
• cyclosporine 5 mg per kg of body weight

Due to the possibility of developing adverse events during retinoid therapy (changes in transaminase levels, hepatitis, hypertriglyceridemia, hypercholesterolemia, hyperglycemia, etc.), it is necessary to monitor lipid levels, blood glucose, and liver function. Due to the teratogenic properties of retinoids, women of reproductive age should use reliable contraceptive measures 4 weeks before, during and for 2 years after the end of acitretin therapy. If pregnancy occurs, it should be terminated for medical reasons.

During treatment with cyclosporine, regular monitoring of plasma creatinine concentration is necessary - an increase may indicate a nephrotoxic effect of the drug and requires a dose reduction: by 25% with an increase in creatinine by more than 30% from the original, and by 50% if its level doubles; when a dose reduction within 4 weeks does not lead to a decrease in creatinine, cyclosporine is canceled. It is recommended to monitor blood pressure, blood levels of potassium, uric acid, bilirubin, transaminases, lipid profile. During the treatment period, immunization with live attenuated vaccines is contraindicated.

Prevention

There are no methods of prevention

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Many in modern times are faced with damage to the skin, hair, nails, fungal infections, popularly called "lichen". This disease brings us discomfort, not only internal, but also external, manifested by rashes on the face and body of a person. Doctors in their terminology use the scientific terms "dermatomycosis" and "dermatophilia". Ringworm accounts for 1% of all skin diseases. Treatment of lichen with folk remedies is a burning problem and is close to everyone. How to treat such an ailment and an ugly aesthetic defect, we will consider in our article.

What is deprive? Types of lichen

Pityriasis rosea Pityriasis rosea Pityriasis rosea Lichen planus Red lichen planus Red lichen planus

pink lichen(deprive Gibert) - chronic dermatosis. Skin disease, characterized by the appearance of red scaly spots, has an infectious or viral etiology. Also, the recurrence of the disease occurs against the background of stress.

Lichen planus- recurrent inflammatory skin disease is characterized by the appearance of papules, which can merge into a single whole forming plaques, accompanied by itching and flaking.

Causes of occurrence:

• Cool weather. Cold.
• Weak immunity. And concomitant infections in the body.
• Often, lichen can occur against the background of an acute respiratory viral infection.
• The occurrence of lichen planus is promoted by drugs that include arsenic, bismuth, gold.
• The body's predisposition to pink and red lichen.
• Development can serve as mental trauma, stress.

Symptoms of pink deprivation

Initially, a “maternal spot” appears on the human body - a small pinkish plaque up to 5 cm in size, which begins to peel off and wrinkle in the center. After 10 days, the skin begins to become covered with small oval pink spots, which also begin to peel off. The rashes are initially localized on the chest, further spreading to the abdomen, inguinal folds, legs, neck, shoulders, and rashes can also be on the face.

The process is accompanied by fever, itching and enlarged lymph nodes.

Symptoms of lichen planus

Characterized by a symmetrical rash, papules up to 4 mm in size with a smooth, shiny surface on which you can see a clear mesh pattern. Plaques of lichen planus are located on the flexion surfaces of the hands, legs, glans penis, vagina, trunk, face and gums. Papules have a color from pink to cyanotic, dark. A rash of lichen planus is accompanied by moderate itching.

Lichen planus and rosea are not contagious in their etiology, but can be transmitted through personal hygiene products (towel, comb, washcloth shoes, etc.)

Lichen treatment

You can accurately determine the diagnosis or type of lichen from an infectious disease specialist or dermatologist based on anamnesis. The type of lichen will help determine dermatoscopy. In the same place, the doctor will also prescribe medicines for this unpleasant ailment. Often these are anti-inflammatory, antiviral, antihistamines, immunotherapy can be prescribed by a doctor. Bubbles, rash is treated with antiseptic drugs (furatsilin and brilliant green).

Lichen treatment at home

• An effective method will help treat lichen with the help of lemon and garlic . Lemon and garlic must be grated. Apply the mixture for several hours to the affected areas of the body. After several applications, itching is reduced, the skin takes on a natural, healthy look.

• Compresses with birch tar help treat red and pink lichen. Mix birch tar and fish oil in equal proportions. Apply this mixture on gauze and apply for several hours to the area affected by plaques. After removing the compress, after 2 hours, zinc ointment must be applied to the skin.

• Infusion of wormwood will help cure lichen and get rid of plaques on the body. Pour 2 tablespoons of ordinary wormwood with a glass of boiling water, let it brew and then strain. Use this solution for baths and lotions for the affected areas on the body.

Ointment from propolis and fat

As fat, you can use salicylic or vaseline ointment, olive oil. For 80 grams of fatty ointment, we take a slightly chilled and finely chopped propolis, mix and smear the affected areas on the body of a sick person, then cover with a napkin. This method will help to get rid of the hated disease forever.

• Celandine juice mixed with vodka in equal proportions, you can get rid of an unpleasant disease forever. Lubricate the affected areas with this mixture.

• An effective remedy at home - wiping plaques WithOK om of calendula flowers . This method is good for young children, does not cause allergies and quickly eliminates itching.

• Another method to treat lichen is to smear the affected areas of the skin. cranberry juice . Quickly and irrevocably eliminates the disease and aesthetic defects.

Prevention of lichen planus

Lichen brings great discomfort, rashes appearing on the face and body of a person provoke complexes and a feeling of detachment from the whole world. In order not to get infected with fungal infections, you need to know preventive measures.

1. Refusal of such places where there is a risk of infection with fungal infections: swimming pool, solarium, beauty and massage parlors.
2. Wear clothes made from natural fabrics, It is useful and pleasant, the skin breathes.
3. Exclusion from the diet of foods that provoke the appearance or aggravation of fungal infections (dairy, sweet, fish, citrus products, spicy, salty, smoked foods and alcohol).

(lichen ruber planus) is a chronically occurring dermatosis, the characteristic and only element of which is the papule. The disease can be with damage to the skin, mucous membranes and nails. The variety of appearance of papules, their localization and grouping causes a large number of clinical forms of lichen planus. For diagnosis in difficult cases, a biopsy is performed. Lichen planus is treated with antihistamines, corticosteroids, antimalarials, PUVA, and phototherapy.

Most often, lichen planus affects the skin of the flexor surface of the extremities, inner thighs, axillary and groin areas, torso and oral mucosa. With lichen planus, changes in the nails can be observed: the appearance of longitudinal striation and scallops on them, clouding of the nail plate, destruction of the nail fold. The palms, soles, scalp, and face are usually not affected by lichen planus.

A quarter of patients with lichen planus have a mucosal lesion that is not accompanied by skin rashes. Papules are located on the oral mucosa, the vestibule of the vagina or the glans penis. They can be single or grouped in the form of lace, mesh, rings. The color of the papules on the oral mucosa is grayish-opal. Whitish flat plaques with jagged edges form on the tongue, and purple small plaques with a slightly scaly surface form on the lips.

Signs characteristic of lichen planus include the symptom of Wickham's net - the detection of a reticulate pattern on the surface of the largest papules. It is well defined after lubrication of the papules with sunflower oil. During the period of exacerbation of lichen planus, the Koebner phenomenon is observed - the formation of new papules at the site of skin injury.

Hypertrophic (warty) form of lichen planus It is characterized by warty layers caused by hyperkeratosis on the surface of brownish-red or purple plaques. There are separate nodules around the plaques. The favorite localization of rashes of the hypertrophic form of lichen planus is the anterior surface of the legs. Sometimes there are separate foci of hyperkeratosis on the upper limbs and on the face. According to the clinical picture, they may be similar to basalioma or senile keratosis.

Atrophic form of lichen planus develops in connection with sclerotic and atrophic changes at the site of resolution of rashes. Small patches of alopecia may be observed on the scalp.

Pemphigoid (blistering) form of lichen planus manifested by the formation of vesicles (vesicles) with serous or serous-bloody contents. Vesicles can appear both on apparently healthy skin and on the surface of plaques and papules. Often, along with the vesicles, there are rashes typical of lichen planus. The usual localization of this form of the disease is the skin of the legs and feet. When large blisters occur, they speak of a bullous form of lichen planus.

Moniliform lichen planus characterized by rounded waxy rashes grouped in the form of a necklace. The rash is located on the forehead, behind the auricles, on the neck, back of the hands, elbows, abdomen and buttocks. At the same time, the skin of the nose, cheeks, interscapular region, palms and soles remains intact.

Pigmentary form of lichen planus along with the characteristic elements of the rash, it is accompanied by the appearance of pigment elements: brown spots and dark brown nodules. Sometimes they may precede the rash typical of lichen planus.

Genital form of lichen planus localized mainly on the skin of the neck, shoulder blades and lower extremities. Its elements are pointed papules. In the center of each papule there is an area of ​​hyperkeratosis, protruding upward in the form of a horny spine.

Ring-shaped lichen planus is formed as a result of peripheral growth of the lesion with regression of elements in its center. Thus, the rashes form half rings, rings and arcs. The ring-shaped form of lichen planus is most often found in men on the skin of the inner surface of the legs and in the genital area.

Erosive and ulcerative form of lichen planus observed on the mucous membranes, more often in the oral cavity. It is characterized by erosions and ulcers surrounded by an edematous and red mucosal area with typical lichen planus rashes on it. Erosions heal for a very long time, sometimes for years. After healing, recurrences of erosions often occur in the same place or on previously unaltered mucosa.

Rare forms of lichen planus include erythematous, obtose, and serpigiosum.

Diagnosis of lichen planus

The presence of typical skin rashes allows a dermatologist to diagnose lichen planus based on the clinical picture. However, the variety of clinical manifestations and the existence of rare forms of lichen planus cause certain difficulties in its diagnosis in individual cases. This mainly concerns lichen planus of the mucous membranes.

In patients with lichen planus, no specific changes are observed during laboratory tests. In some cases, a clinical blood test may show leukocytosis, eosinophilia, and an increase in ESR.

In doubtful cases of lichen planus, a biopsy is necessary to confirm the diagnosis. Histological examination of the biopsy specimen reveals inflammation, hyperkeratosis, hydropic degeneration of the basal layer of the epidermis, hypergranulosis, band-like infiltration of the upper layer of the dermis, colloidal Sevatt bodies at the border of the dermis and epidermis.

Treatment of lichen planus

The lack of a clear understanding of the causes and mechanisms of development of lichen planus causes a variety of methods for its therapy. Treatment is carried out with the use of drugs that have a calming effect on the nervous system and relieve itching (chloropyramine, clemastine, cetirizine).

Some of the treatments for lichen planus are PUVA therapy and selective phototherapy. Another technique is the combined use of corticosteroids (prednisolone, betamethasone) and antimalarial drugs (chloroquine, hydroxychloroquine).

In most cases of lichen planus, topical therapy is not performed. The exception is the hypertrophic form, in which dressings with steroids, intralesional injections of diprospan, destruction of growths with a laser or radio wave are indicated. With lesions of the lichen planus of the mucous membranes, vegetable oils, corticosteroid ointments, phytoextracts, etc. are applied topically.

If a person has characteristic rashes on the mucous membranes and skin, then most likely he has developed contagious lichen erythematosus (red dermatitis, pink lichen). This chronic inflammatory disease is the most common pathology of the oral cavity. In an adult, lichen planus occurs much more often than in a child, but it is equally difficult to cure it, because the symptoms are similar. The disease looks like a normal dermatosis, but differs from its other varieties in that it appears against the background of already existing problems with internal organs.

What is lichen planus

This is a chronically occurring dermatosis, the characteristic element of which is the papule. Pathology affects the skin, nails, mucous membranes. The variety of papules, their localization, appearance and the presence of groups causes a huge number of forms of lichen planus. More often the disease is detected in women 40-60 years old. The disease proceeds slowly, relapses alternate with periods of subsidence of clinical symptoms. Elderly people and children rarely get lichen planus.

Is it contagious

Doctors have not yet been able to find a definite answer to this question. It is believed that lichen planus is not contagious. However, in medical practice, there are facts of the occurrence of pathology in all family members. An episode was also documented when a doctor who took tissue from a patient found a pointed papule on his skin a week later. A month later, the doctor developed numerous rashes similar to those that were present in his patient. It can be assumed that infection with red dermatitis is possible through close contact.

Symptoms

The most characteristic sign of red lichen is Wickham's mesh. It is a pattern on the surface of large papules, which is perfectly visible when vegetable oil is applied to the rash. Lichen planus looks like a collection of small nodules alternating with compacted plaques. Skin with red dermatitis looks like a glossy sheet of paper, which has a purple-cyanotic tint. Symptoms of lichen planus are difficult to confuse with another skin problem, because with its development it is easy to notice whitish dots and stripes, which are a thickening of the stratum corneum of the epidermis.

In children

In appearance, lichen planus is not much different in adults and children. The first rashes are localized on the legs and arms in the area of ​​​​the joints of the child. Then the red dermatitis spreads to other parts of the body, and small shiny papules are grouped on the skin, resembling a ring. On the joints, seals are harder than on other parts of the skin. The vesicular form of lichen is expressed by fluid-filled vesicles, which are localized at the site of foci of chronic inflammation. They can affect the mucous membrane of the child's mouth and be accompanied by itching, which provokes sleep disturbance.

Causes

There are many theories about the etiology of the disease:

1. Hereditary. Based on some cases of disease of relatives in the 2nd and 3rd generation.
2. Neuroendocrine. The main reason is emotional stress, long-term mental disorders, dysfunction of the nervous system due to certain diseases (early menopause, hypertension, hypoestrogenism, and others).
3. Allergic. It is based on the toxic-allergic reaction of the body to chemicals, vitamins and drugs, food products.
4. Viral. Red lichen is explained by the presence of a filtering virus in the body, which is activated when immunity is reduced.
5. Metabolic. It is based on the common development of lichen planus and diabetes mellitus, which often occur together.

Classification

According to clinical manifestations, red dermatitis is classified according to the type of disease:

Diagnostics

At the first symptoms of a skin disease, you should contact a dermatologist. The diagnosis of "lichen planus" is carried out on the basis of a visual examination and is not difficult. Plaques of a polygonal shape of a smooth surface with a characteristic color of rashes indicate red dermatitis. To clarify the diagnosis, the following laboratory tests are carried out:

• skin biopsy;
• histological examination of the biopsy.

Treatment of lichen planus

The lack of clear knowledge about the causes of the disease causes the use of different schemes and methods of its treatment. Drug therapy is carried out with the use of sedative drugs and drugs that relieve itching. Selective phototherapy and PUVA therapy effectively fight the disease. Another treatment for red dermatitis is the combined use of antimalarial and corticosteroid drugs.

In most cases, local therapy for lichen planus is not prescribed. The exception is the hypertrophic form of the disease, in which dressings, intralesional injections, destruction of lesions by radio wave or laser are used. If the nodules are located on the mucous membranes, then phytoextracts, corticosteroid ointments, and vegetable oils are recommended for treatment.

Medications

For the treatment of red lichen, a wide range of medications is used:

1. In the acute and subacute course of the disease, the sedative drug Medazepam is prescribed, which calms the nervous system and relieves stress. The disadvantage of taking the medication is the possibility of developing multiple side effects.
2. With very common rashes, the doctor prescribes the antiviral drug Zovirax. The medicine has contraindications: renal failure, neurological symptoms.
3. Additionally, vitamin E is prescribed, which reduces the duration of treatment. With its overdose, apathy, loss of vision, and digestive problems can be observed.
4. To eliminate the painful itching, the doctor will recommend the antihistamine Cetrin, which reduces inflammation. The drug is not prescribed during pregnancy and lactation.
5. If complications arise that are associated with erosive and ulcerative lesions of the skin or the addition of a secondary infection, then the antibiotic Tetracycline is treated. Among the disadvantages of its use are multiple adverse reactions.
6. With long-term treatment, the corticosteroid Dexamethasone is additionally prescribed. There are risks of getting allergic and dermatological reactions after using the medicine.

Ointment

Doctors in dermatovenereology, in addition to drug treatment, recommend the use of external agents. The best ointment for lichen planus on the mucous membranes is Flucinar. This is a glucocorticosteroid drug that has anti-allergic, antipruritic, anti-inflammatory effects. It is applied within 1-2 weeks on the damaged mucosa with applications. Do not prescribe ointment to children under 2 years of age.

To quickly cure a disease of external origin, Advantan ointment is recommended. It relieves itching, swelling, removes inflammation, pain syndrome. The ointment is applied to the affected surface 1 time / day until the lichen disappears completely. Among the disadvantages of using Advantan is that it cannot be used for skin tuberculosis, rosacea, skin manifestations of syphilis.

Physiotherapy

It will be easier to get rid of red lichen if, in addition to tablets and ointments, you undergo a course of physiotherapy. Main methods:

• PUVA therapy - the combined effect of photosensitizers and ultraviolet radiation, which gives an anti-inflammatory effect;
• magnetotherapy, which improves tissue regeneration;
• applications of ozokerite, which have a resolving effect.

Treatment of lichen planus at home

So that red lichen does not cause atrophic baldness of the scalp, along with the main treatment, alcohol tincture of calendula, which is easy to find in a pharmacy, should be used. Rub the product into the affected areas of the scalp, preferably several times a day. Judging by the reviews of patients, sea buckthorn oil helps to cope with lichen planus, which must be applied to gauze daily, leaving the lotion on the site of inflammation for at least 1 hour.

Diet

During the course of the disease and during the recovery period, you need to adhere to a balanced diet. The diet for lichen planus includes drinking plenty of fluids, avoiding fast food, fatty, smoked, salty, spicy foods, concentrates, and eating foods rich in minerals and vitamins. It is necessary to include in the diet:

• dried prunes, dried apricots;
• fresh fruits and vegetables;
• any fresh herbs;
• raisins, nuts;
• rosehip decoction.

Treatment with folk remedies

Our ancestors tried to cure red lichen with the help of folk recipes. With the development of medicine, self-treatment has become less effective, but in combination with modern methods, grandmother's methods provide a faster recovery. When plaques form, it is recommended to use the following folk recipes:

1. Apple vinegar. Should only be used at home. Vinegar is used in the form of lotions, applying gauze for 10 minutes to the affected area. It is recommended to carry out at least 5-6 procedures per day.
2. Birch tar. Effective ointment, which is prepared from 150 g of tar, 2 egg yolks and 100 g of fresh cream. Apply to lichen throughout the day as often as possible.

Far from medicine, people often combine diseases transmitted from animals and scare them to children who strive to stroke a furry stranger. In fact, in dermatology there are several diseases, in the name of which the word "lichen" appears, but at the same time they are completely different in nature.

What is lichen planus?

It occurs in about 1% of patients with skin diseases, most often occurs in people aged 40-60 years, but people of any age are susceptible to it.

According to statistics, lichen planus is more often detected in women. A characteristic feature of the disease is many different forms, each of which has its own clinical picture and affects certain parts of the body.

Reasons for the development of LP

Until now, doctors have not established what exactly is the cause of the development of the disease.

Doctors are inclined to believe that lichen planus is a polyetiological disease.

This means that it develops with a combination of several unfavorable factors for the patient at once.

KPL Forms

There are several forms of the disease that differ in localization and clinical manifestations.

typical shape

It is characterized by the appearance of papules (nodules) of various shapes and sizes. In the center of the pathological element, an umbilical depression can be found, which helps doctors in diagnosing. The nodules show the characteristic Wickham mesh (the reason for its appearance is the uneven hypertrophy of the granular layer in the epidermis). In a typical form of the disease, the skin of the trunk, oral mucosa, and genital organs are affected. In addition to the nodules on the body, the patient is worried about severe itching.

Hypertrophic (warty) form

With this form, the papule is more strongly than usual, rise above the surface of the skin. On them, you can see growths in the form of papillae, with keratinization (hence the resemblance to warts).

With this form of the disease, the skin of the scrotum, shins, hands, and sacrum are more often affected.

Sclerosing (or atrophic) form

It differs from the typical one in that after the disappearance of the papule, a small atrophic scar or focus with a brown center and a small roller along the edges remains on the skin. Localization: scalp, armpits, torso, genitals (usually on the head of the penis).

Pemphigoid (bullous) form

This is a fairly rare form of lichen planus. With it, blisters form on papules or sometimes unchanged skin (bulls - hence the name). Everything is accompanied by severe itching, which provokes patients to damage the blisters and comb them to erosions and even ulcers. In most cases, the lower extremities are affected.

pigment form

It appears as brown spots that are located on the skin of the trunk, face, limbs.

To make a correct diagnosis, doctors try to detect typical nodules, which is sometimes quite difficult.

Linear form

In this case, pathological elements appear linearly along the nerve fibers. In most cases, children are affected.

zosteriformis

It is so called because of the similarity of symptoms with HerpesZoster. Papules appear along the nerve fibers in large quantities. The duration can be acute (about one month), subacute (about six months) and long-term.

Pathological elements in this case appear on the oral mucosa, affect both halves symmetrically.

At the same time, the quality of human life is greatly reduced, since even a simple conversation can bring discomfort.
The pattern of the rash often resembles a light mesh.

Symptoms of LP

The manifestations of the disease can be different, depending on which form has developed in a person. What lichen planus looks like and the features of the most common forms can be read above, as well as where the rash is localized.

Is lichen planus contagious?

Outwardly, the disease can cause quite unpleasant associations and even discomfort among others, but you should not be afraid of it.

As can be concluded from the causes of the development of the disease - lichen planus is not transmitted from person to person.

LP diagnostics

The diagnosis is made by the doctor on the basis of the clinical picture and the patient's complaints. If necessary, a biopsy of the altered skin area can be taken, followed by a histological examination.

Treatment with drugs for lichen planus in humans

What and how to treat a patient with lichen planus on the body and other organs is decided by a dermatologist. If the disease is mild, then a hypoallergenic diet, sedatives and antidepressants (for example, azafen) help to cope with it. Sometimes penicillin antibiotics or tetracyclines are effective. Since there is an immunological component in the pathogenesis, histamine blockers are prescribed (loratadine, diazolin, zyrtec, suprastin).

The moderate form can be treated with a course of prednisolone in small doses, vitamin therapy is carried out (vitamins A, E, aevit drug). Actovegin, Solcoseryl, drugs that affect metabolism, contribute to the rapid recovery of the skin. Use drugs containing quinolone (delagil, chloroquine)

The generalized form is treated with more powerful drugs. An example is cyclosporine used before clinical effect.

Local treatment

Corticosteroid ointments are actively used, which have an anti-inflammatory effect and are therefore effective in the treatment of lichen planus, chipping foci with hydrocortisone. From instrumental treatment, laser and diathermocoagulation are increasingly being used.

Forecast

Subject to the recommendations of specialists, patients successfully control the course of the disease and live a full life. The frequency of exacerbations may be different, but they do not threaten life. The ability to work with red flat deprives is also preserved.