Lichen planus in humans
Lichen planus in humans is a chronic dermatosis, a sign of which is the formation of a single papule. The disease can affect the skin, nail plates and mucous membranes.
There are many clinical forms of the disease, since rashes can have a different appearance, form in different places, and group in different ways.
Statistics indicate that in the total mass of all dermatological diseases, lichen lichen is diagnosed in 1.3-2.4% of cases. As for the mucous membranes of the mouth, in this case, the percentage of detection of red skin lichen is much higher and amounts to 35%. Researchers point to a noticeable trend towards an increase in the incidence of this type of lichen in recent years. According to available data, from 0.1% to 4% of people will suffer from this ringworm at least once in their life. The disease affects people of all ages, more often women.
In the mouth, this disease is more often detected in people in the age range from 50 to 60 years, and on the skin at the age of 40 to 45 years. Children are less susceptible to pathology, it is extremely rare in them.
- Symptoms of lichen redness
Causes of the appearance of lichen red
- Could lichen planus be associated with stress?
- Could lichen planus be associated with allergies?
- Can lichen planus be caused by medications?
Is lichen planus dangerous? Consequences and complications
Is it true that lichen planus can lead to cancer?
- Diagnostics of the red lichen
Answers to popular questions
- Is lichen planus contagious? Is it passed from one person to another?
- How and for how long does lichen planus go? Could it be chronic? Can it develop repeatedly?
- Can I sunbathe at the sea or in a solarium if I have lichen planus?
- Is it possible to wash in the shower or take a bath with lichen planus?
- How can lichen planus affect pregnancy?
- How is lichen planus treated?
Symptoms of lichen redness
Symptoms of lichen planus are various, however, they all boil down to the formation of a monomorphic rash, which consists of small flat papules with a diameter of up to 0.5 cm.
- The nodules can be reddish-purple or crimson-red. The center of the papules is retracted, their surface shines. The nodules are especially visible under side illumination.
- Peeling, as a rule, is not very pronounced. The scales are difficult to separate. Sometimes peeling resembles a picture of psoriasis. In this case, we are talking about the psoriasiform type of the disease.
- Multiple eruptions prevail when the nodules are located in groups. They can combine into garlands, stripes, circles, and can merge to form plaques. Elements of the rash are again formed around these fusions. After the nodules are resolved, an area with persistent red pigmentation remains on the affected area.
All rashes give the patient anxiety in the form of severe itching. This often leads to problems with night rest, eventually provoking neurotic disorders. Seals that are localized on the fingers itch the most. Therefore, many people mistake lichen for scabies. (read also: Scabies - Causes and Symptoms)
- The favorite places for localization of rashes are the elbow bends, knee bends, inner thighs, inguinal area, armpits, human torso and the oral mucosa. It is possible to include nail plates in the pathological process with the subsequent destruction of the nail fold.
- The scalp, palms, soles and face are not attractive sites for inflammation caused by lichen planus. Nevertheless, in about 10% of people, the pathology captures the head with its hairy part and the face. In this case, the lichen looks like a dark red seal that itches a lot. As the pathology progresses, hair begins to fall out from the head.
In 25% of people in whom lichen has formed on the mucous membranes, papules do not appear on the dermis. They affect the oral cavity, the head of the penis, the entrance to the vagina. They can be grouped into rings, circles, net. On the mucous membranes, the shade of the nodules is grayish. If the tongue is involved in the pathological process, then flat plaques with jagged edges form on it. If the lips are affected, then purple plaques with unexpressed peeling at the top are visible on them.
- In women, lichen localized in the genital area can narrow the urethra and disrupt the emptying process of the bladder. Often, lichen becomes the cause of pain that occurs during intimacy, can cause irritation and itching in the perineal region.
- The Wickham grid symptom is another characteristic symptom of the disease. It manifests itself in the fact that a mesh-like pattern is formed on the surface of large papules. It can be visualized especially well if vegetable oil is applied to papules.
- The Kebner phenomenon is another symptom of the disease, characteristic of the stage of exacerbation of lichen. It is expressed in the fact that new papules are formed on the areas of the skin where the injury was inflicted.
It is known that this type of lichen has a variety of clinical forms, each of which is slightly different in one way or another.
So, the symptoms of lichen lichen in its various forms will be as follows:
- For the hypertrophic, or, as it is also called, the warty form of lichen, the appearance of lumpy layers is characteristic. Their color can be purple or brownish red. The nodules are located around large plaques. Most often, the warty form affects the legs. Sometimes the face and hands are involved in the pathological process. It is necessary to differentiate this form of the disease from senile keratosis and basal cell carcinoma.
- When lichen develops on an open area of the skin, or on the scalp, where atrophic and sclerotic changes are already taking place, then we are talking about the atrophic form of lichen planus. On the head, this pathological process leads to the appearance of small areas of baldness.
The blistering form of the disease will manifest itself in the appearance of vesicles containing serous contents (sometimes mixed with blood). Bubbles form both on healthy skin and on top of existing papules and plaques. In addition to vesicles, a rash typical for lichen planus appears on the dermis. The blistering form of the disease most often affects the legs and feet. When the blisters are large, this form of the disease is called bullous.
- The moniliform variety of the disease manifests itself in the appearance of a rash that has a waxy sheen on top. The elements of the rash themselves form in the necklace. The priority places for such rashes are: ears, neck, forehead, elbows, buttocks, abdomen.
- The acute-pointed form of the disease is characterized by the appearance of elements of a rash in the form of pointed papules on the lower limbs, shoulder blades and neck. In the middle of each formation there is a horny fat, which is a site of hyperkeratosis.
- The pigmented form of the disease is manifested in the fact that, in addition to the elements of the rash, spots appear on the skin that have a brown tint, as well as nodules of a dark brown color. Staining may occur before the rash appears.
Ring-shaped form of the disease. The rashes form whole or half circles. Most often, this form of lichen is diagnosed in the male population and affects the genital area, as well as the inner surface of the legs.
- The erosive and ulcerative form of the disease affects the mucous membranes, most often the oral cavity. At the same time, non-healing ulcers appear on the tissues for a long time, the surrounding mucous membrane swells and turns red. Sometimes such rashes can exist for years, and after they disappear, there is a high risk of recurrence.
It is extremely rare that people are diagnosed with an erythematous, serpigious and obtuse form of the disease.
Reasons for the appearance of lichen red
Although many scientists have been and continue to be engaged in establishing the cause of the appearance of lichen planus, nevertheless, it still remains unclear. Therefore, modern researchers call lichen planus a multi-cause disease. That is, it develops under the influence of a number of factors, both exogenous and endogenous.
The most likely causes of lichen planus are considered to be the following:
- Neurogenic cause. The disease begins to develop, or recurs as a result of psychological trauma. Often in patients with a similar dermatological problem, vegetative neurosis, neurasthenia and other mental disorders are simultaneously detected. It was found that rashes against the background of existing neuritis are often located along the nerve branches.
- Viral cause. Some scientists are of the opinion that the pathogenic microorganism that provokes lichen planus simply exists for a long time in human epidermal cells. Under the influence of certain factors that weaken the immune system, it is activated and causes the acute stage of the disease.
Inherited transmission of the disease. The adherents of this theory of the development of the disease indicate that in 0.8-1.2% of patients, the fact of the occurrence of lichen planus in several generations was confirmed. Moreover, the disease often manifested itself in childhood and proceeded with constant relapses.
- Taking certain medications.
- Autointoxication of the body when an excessive amount of toxins accumulates in it. These processes can be associated with liver diseases, for example, with cirrhosis or hepatitis, with diseases of the gastrointestinal tract (ulcer, gastritis), with endocrine diseases (diabetes mellitus), with pathologies of the heart and blood vessels.
Immunoallergic theory. She explains the mechanism of the development of the disease, starting from disorders in the functioning of the immune system. At the same time, the body's immunity perceives the cells of its own skin as foreign and begins to destroy them with the help of antibodies, leukocytes, immunoglobulins, etc. Due to such pathological activity of immunity, substances that lead to the development of inflammation begin to be produced in certain areas of the dermis. The cells of the upper layer of the skin or mucous membranes die, as they become unable to withstand constant attacks. This theory is confirmed by the fact that patients with lichen planus often have other immune diseases, such as: alopecia areata, vitiligo, ulcerative colitis.
- Mechanical damage to the skin. The emergence of new foci of inflammation is possible in those places where there is mechanical damage to the skin. For example, in places of constant friction with clothing or jewelry.
- Kebner's reaction. The appearance of lichen ulcers in the oral cavity may be associated with the traumatic effect on it of the sharp edges of existing or partially missing teeth, improperly installed dentures, and biting the cheeks.
Could lichen planus be associated with stress?
Studies were carried out, which boiled down to long-term observation of patients diagnosed with lichen planus. They confirmed that the occurrence of this disease and its relapse can be triggered by severe stress. The transferred negative emotions, overwork, experiences had a negative impact on the course of the disease.
Could lichen planus be associated with allergies?
The disease may be associated with allergies, as evidenced by the available clinical studies. This is especially true for a disease that affects the oral cavity. Often, an allergic reaction occurs to the components that make up dentures or fillings, or to components of toothpaste (this is especially true for cinnamic acid). Sometimes it is enough to simply eliminate an existing allergen to get rid of the disease.
Can lichen planus be caused by medications?
Medicines can also cause lichen red, but this is not common. The danger in this regard is represented by anti-inflammatory and analgesic drugs: Aspirin, Diclofenac, Ibuprofen, etc. Angiotensin-converting enzyme inhibitors, some drugs for the treatment of malaria or tuberculosis, preparations of gold, iodine, aluminum, arsenic, quinine and all its derivatives, antibiotics can provoke the disease groups of tetracyclines and derivatives of sulfonylureas.
Is lichen planus dangerous? Consequences and complications
Although in most cases lichen planus does not pose a serious threat to human health, nevertheless, sometimes it can provoke serious complications, including:
Temporary darkening of skin areas where the foci of inflammation were located.
- The formation of scars and depressions in the skin.
- Hair loss without the possibility of their subsequent restoration.
- The appearance of adhesions and scars that can lead to narrowing of the vagina in women and phimosis in men.
- Loss of vision, or narrowing of the lacrimal canal (with eye damage).
- Severe deformation of the nail plates.
Is it true that lichen planus can lead to cancer?
Lichen planus, which affects the skin, cannot lead to cancer. If foci of inflammation occur in the oral cavity, then such a risk exists. Rebirth does not happen immediately, but over time.
A study was conducted that revealed that after a certain period, lichen planus will lead to the development of oral cancer in 2% of patients.
To minimize this risk, you should stop smoking, include fresh vegetables and fruits in your diet. When there is cause for concern, you should seek immediate medical attention.
On the subject: Treatment of cancer with folk remedies
Diagnostics of the red lichen
Diagnosis of lichen planus by a dermatologist is not difficult if it proceeds in a typical form. Due to the fact that the clinical picture of the disease is very variable, additional examination methods may be required, in addition to the standard examination and collection of anamnesis. This is especially true for lichen red, located on the mucous membranes.
Laboratory diagnostics is most often uninformative, although in some cases a clinical blood test reveals leukocytosis, an increase in ESR and eosinophils.
Therefore, if the doctor has any doubts, he sends the patient for a biopsy. Based on the histological examination of the biopsy specimen, it will be possible to judge the presence of hyperkeratosis, inflammatory reaction, hypergranulosis, dystrophy of the epidermal layer and its infiltration, and the presence of Sevatt colloidal bodies.
If there is a suspicion of the presence of lichen planus in the nasal cavity or in the esophagus, then it is possible to prescribe EGD and consult an ENT doctor.
Answers to popular questions:
- Is lichen planus contagious? Is it passed from one person to another? Lichen planus is not contagious, it is not transmitted from person to person. However, hepatitis C can be a factor influencing the development of lichen. In turn, hepatitis C is a contagious disease, therefore, in the presence of symptoms of dermatological diseases, it is necessary to see a doctor.
- How and for how long does lichen planus go? Could it be chronic? Can it develop repeatedly? After the first appearance on the skin, lichen planus can remain on them from six months to 2 years. After this time, the lichen passes. However, the risk of relapse is not excluded. If the oral mucosa is affected, the disease has a longer course and can exist for 5-20 years with periods of calm and exacerbation.
- Can I sunbathe at the sea or in a solarium if I have lichen planus? Lichen planus is not a contraindication for swimming in the sea or spending time in the sun. Only one extremely rare form of lichen is dependent on ultraviolet rays - radial lichen lichen. But this variety is found only in the inhabitants of India, Africa and the Middle East. However, doctors still do not recommend overusing tanning, as in this case there is a risk of developing skin cancer (not associated with shingles).
- Is it possible to wash in the shower or take a bath with lichen planus? You can shower and take a bath without any fear. These water procedures do not affect the development of the disease.
- How can lichen planus affect pregnancy? There are no data on the effect of lichen planus on the course of pregnancy. Nevertheless, if there is a fact of the disease, a visit to a doctor is necessary.
How is lichen planus treated?
The answer to the question of how to treat lichen planus can only be given by a doctor, since therapy will be based on how far the infection has gone.
Sometimes the disease goes away on its own, in order to speed up this process, a specialist may recommend:
- Taking medications aimed at lowering the activity of the immune system;
- Preparations aimed at improving trophism and tissue regeneration;
- Drugs that relieve itching, normalize the work of the nervous system;
- Ointments for local treatment.
So, drugs aimed at treating lichen planus in case of violation of the patient's condition may be as follows:
- Immunosuppressive drugs (Cyclosporin A, Hydroxychloroquine). The effect in the form of papule blanching, ulcer healing, and reduction of puffiness can be seen a month after the start of therapy. Remission after withdrawal of immunosuppressive drugs lasts a long time.
- Systemic corticosteroids (Metipred, Prednisolone). The effect occurs rapidly, papules disappear after a few days, swelling and hyperemia quickly disappear, itching is relieved. However, taking hormonal drugs is always associated with the risk of serious side effects. In addition, after the abolition of these drugs, there is a high probability of a relapse of the disease with an increase in symptoms.
- Interferons and interphenogens of synthetic origin (Neovir, Ridostin, Interferon-Alpha 2b). These drugs help relieve the local inflammatory reaction, accelerate the healing of the skin.
- Vitamin A derivatives (Tigazon, Neotigazone, Isotretinoin, Acitretin). The action of the drugs is aimed at accelerating the healing of ulcers and erosions, at reducing inflammation and edema.
- Antiallergic agents (Zyrtec, Clemastin, Parlazin, Suprastin, Fenkarol, Promethazine, Hydroxyzin, Loratadin, Cyproheptadine, Diazolin). The drugs act quickly, help relieve swelling and itching, are especially effective when the disease is provoked by an allergic reaction.
- Antibacterial drugs are prescribed for severe disease and with the addition of a secondary infection. Most often, drugs from the group of tetracyclines and macrolides are recommended for admission.
Local treatment is reduced to applying ointments to the skin. They help reduce itching, improve nutrition, relieve inflammation and eliminate rashes.
For the treatment of lichen planus, the following ointments can be used:
- Based on hormones: Hydrocortisone, Flumethasone, Cloveit, Triamcinolone, Betamethasone. Itching decreases 15 minutes after application, the general condition of the skin improves by 1-3 days from the beginning of the intake. The therapeutic course should not exceed 14 days.
- Non-hormonal ointments: Gistan, Fenistil. These remedies work well with lichen planus caused by an allergic reaction of the body. It is possible to quickly achieve relief from itching, swelling, redness. The reverse development of papules is accelerated.
- Non-hormonal ointments with anti-inflammatory effect: Pimecrolimus, Tacrolimus. The course of treatment should not exceed 6 weeks.
- Ointments that help exfoliate the dermal integument, quickly soften papules, relieve swelling and redness: Salicylic ointment, or products based on it with the addition of hormones (Diprosalik, Belosalik).
- Solcoseryl ointment will contribute to the healing of wounds and erosions.
Ancillary methods of treating lichen planus are physiotherapeutic methods: PUVA therapy, laser therapy, magnetotherapy.
No less important is the treatment of concomitant diseases: diabetes mellitus, hypertension, liver and gastrointestinal tract diseases. Particular attention should be paid to ridding patients of nervous disorders. Perhaps the appointment of sedatives, vitamin therapy.
The author of the article: Kuzmina Vera Valerievna | Endocrinologist, nutritionist
Education: Diploma of the Russian State Medical University named after NI Pirogov with a degree in General Medicine (2004). Residency at Moscow State University of Medicine and Dentistry, diploma in Endocrinology (2006).
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