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A whole group of skin diseases is united by the general term lichen in humans. Although the causes of all these pathologies are different, people classify them as one group. Moreover, the word “lichen” itself is used for the most part according to the established historical tradition, and does not describe the essence of the biological origin or the medical characteristics of the disease.

The disease can be fungal, viral, or non-infectious in origin, and it is often difficult to outwardly distinguish one condition from another. Therefore, it is impossible to try to diagnose yourself on your own, using a photo from the Internet. Mistakes can lead to the spread of the disease among family members and others, and the condition of the victim himself can worsen greatly.

Among the key characteristics of all lichens, several common points can be distinguished. These include the following:

• all lichen affects the skin;
• typical inflammatory changes in the epidermis;
• elements are located on different parts of the body – single or multiple;
• usually rounded, with relatively distinct borders.

Types of lichen in humans

Different types of pathology have differences in gender and age aspect. Various infectious forms of skin lesions (for example, ringworm) are typical for childhood, pink lichen is especially common in adolescents, herpes zoster – in people over 50 – 60 years old. This is due to the characteristics of the immune system. Some types of lichen, for example, red flat, are more common in women.

In men, especially those with dense vegetation on the face and body, certain forms of the disease are more severe, which is associated with the peculiarities of skin care, excessive sweating and the complexity of treatment.

Ringworm

It is the most contagious of all types of lichen. They usually infect children who have been in contact with infected animals (street or domestic cats, dogs), and then generously reward all family members with infection through close contact. By its nature, ringworm is a mycosis that affects smooth skin (or, more simply, a fungal infection). It is provoked by several types of fungi (dermatophytes) parasitizing on the skin of animals and humans. The most common are trichophytosis with microsporia.

The skin on different parts of the body and the scalp is affected. First, pink spots are formed, which are covered with a halo of small bubbles along the edges. Black dots are visible inside the spot – these are stumps of broken hair. The size of the spot gradually increases, the skin turns red along the periphery, bubbles, ring-shaped elements form, but inside the ring the skin is relatively normal. If the lichen is not treated, new rings form inside the old elements – the elements become like targets.

Ringworm got its name for typical changes in the areas of the skin where hair grows (head, chest in men). Rounded bald spots are formed with a bristle in their center – with microsporia, the hair is broken off at a level of 4 – 5 mm from the edge of the skin and along one line, with trichophytosis – at a height of up to 2 – 3 mm and the stumps are located at different heights, some look like black dots in skin. The surface of the plaque itself is flaky, covered with small crusts.

Pink lichen

The disease is not contagious, and its medical name is erythematous-squamous dermatosis. It is impossible to establish the exact cause today, there is evidence that the lichen is of an infectious origin, often spilling out after SARS. Confirmation of this is the presence of formed immunity to this disease for life, repeated episodes of lichen in later life do not occur. But even close, long contacts with the patient do not lead to the appearance of similar elements in other people.

You need to know what lichen looks like in a person: the very first, “mother’s” plaque, a pink rounded spot covered with scaly scales in the center. After about 7-8 days, small spots in the groin and on the arms and legs are eliminated from it, forming plaques up to 20 mm. Against the background of plaque sieving, catarrhal symptoms occur, and the “maternal” plaque disappears.

The appearance of the elements is typical – the red edges of the plaque and the pale middle, covered with small scales. The spots may coalesce to form larger, uneven patches that disappear in a couple of months without intervention.

A feature of pink lichen is that the elements do not appear in the face and head, feet or hands. If it is Zhiber’s lichen, multiple small spots of pink color are formed.

Lichen colorus

To be precise, it is called pityriasis or multi-colored lichen. This is a fungal disease, but not contagious. The fungus that provokes the development of lichen lives on the surface of the epithelium of any person, but in the presence of a genetic predisposition and under the influence of provocateurs, it forms rashes. Fungi infect hair follicles and epithelium, multiplying and forming yellow-brown, red spots up to 10 mm in diameter. The edges of the elements have a “lace” look. The surface of the elements peels off, it seems that they are sprinkled with bran – hence the name. Spots can merge with each other without treatment, forming elements up to 10 – 20 cm. Most often, rashes appear on the neck and back, in the shoulder and chest area. Under the influence of ultraviolet radiation, they disappear, leaving behind non-tanned areas – pseudo-leukoderma (low-pigmented zones).

Shingles

This is a kind of greeting from childhood to those who, as a child, had chickenpox. It is provoked by the same virus – herpes zoster, for which a feature is typical: after suffering chickenpox, it does not disappear from the body, but remains in the body for life. For many years, he can doze off in the nerve ganglia, without making itself felt. But with immune suppression from chemotherapy, HIV, or serious health problems, especially in the elderly, it reactivates. There is pain and itching in the chest or back, along the intercostal nerves. Then, after a few days, bubbles filled with a clear liquid pour out at the site of the pain areas. The rashes look like stripes of bubbles encircling one or two sides, hence the name. These places are painful, especially from rubbing clothes, crusts gradually form. Even after the sores go away, pain may remain – this is postherpetic neuralgia. In places where there were rashes, pigmentation remains for several weeks.

And one more important point: during the period of rashes, the patient is contagious for those children and adults who have not had chickenpox. The contents of the bubbles contain millions of viruses.

Lichen planus

Another non-contagious form of lichen. The elements are quite specific, they can only be similar to individual forms of psoriasis, it is difficult to confuse them with other types of lichen. Polygonal plaques are formed on the skin, which are slightly raised above the skin, in the center there is a slight depression. The plaques typically do not grow in width, but the plaques may sprout in clusters, itch, and have a surface with large scales. The color of the elements is bright – purple-violet, shine is visible in artificial light. On closer examination, a fine mesh is visible on the surface of the plaques (Wickham’s sign), due to the different thickness of the skin lesion.

This lichen also affects the mucous membranes of the genitals and mouth, forming “frosty patterns” on the surface. Fingernails and toenails may suffer – grooves, turbidity and thickening, foci of erosion (nails crumble) form.

Scale versicolor (psoriasis)

This is not lichen at all as such, but an autoimmune disease, which is correctly called psoriasis. Skin lesions and plaque formation are one of the symptoms of a disease that is not contagious to others and occurs as a result of a breakdown in the immune system. As a result, immune cells mistakenly attack their own tissues, forming foci of inflammation. If the skin suffers, psoriatic plaques or more extensive, large foci are formed.

Foci of psoriasis look like thickened skin, delimited from healthy areas by a bright red roller. The surface is highly flaky, slight itching, formation of small bubbles, cracks, dryness is possible.

The appearance of the rash varies depending on the location – there may be large spots in the hair growth area, on the body – plaques or “drops” of psoriasis.

Lichen symptoms

All manifestations, with the exception of psoriasis and lichen planus, affect only the skin. Inflammatory foci of different sizes are formed, with peeling, vesicles or itching. Not always the external manifestations of lichen can be typical, therefore it is important to consult a doctor, only a specialist can determine the exact nature of the rash.

Treatment for lichen in humans

Outwardly, many types of rashes are similar, especially if they itch and are injured, covered with crusts. Therefore, it is important to visit a dermatologist or therapist to assess the appearance of the elements, associated symptoms and existing diseases.

Diagnostics

The principles of diagnosis differ depending on the type of lichen.

If it is multi-colored lichen, it is necessary to use the Balzer test with an iodine solution. The affected and loosened areas in the area of ​​​​the plaque stain more strongly, forming a spotted appearance. Also, the doctor scrapes the surface of the elements – the falling particles are removed like wood shavings (positive symptom of Besnier). In addition, an examination is carried out under a Wood’s lamp – fungal colonies will give a yellowish glow in the thickness of the skin. The last stage – the study of scraped particles under a microscope – a fungus is detected – dermatophytosis or microsporia.

Ringworm is determined by indicating patients for contacts with possibly sick animals, the presence of elements in family members and the detection of typical plaques. Microscopic analysis of scrapings from the surface of the elements is also performed.

For herpes zoster, the clinical picture and an indication of a previous chickenpox are important. Sometimes they look at the titer of antibodies in the blood to herpes zoster.

Modern treatments

We discussed the treatment of various types of lichen with general practitioner, endoscopist, head of the organizational and methodological office Lidia Golubenko.

In general, the treatment of patients with different types of lichen will be given in four main areas.

first – this is etiotropic therapy (that is, drugs aimed at the cause of the disease): for ringworm and pityriasis, these are antifungal drugs (fungicides), for shingles – antiviral (Acyclovir drugs).

Second – this is the elimination of the symptoms of the disease due to various medicines: they are taken orally or applied topically.

The third – these are various non-drug measures (UV therapy, skin care, physiotherapy, strengthening immune defenses).

And fourth (this item is not always needed) – disinfection in the foci (for clothes, linen and at home).

The drugs that are most often used in the treatment of different types of lichen are:

• antifungal creams, ointments, or tablets;
• antiviral injections, tablets, or topical agents;
• antihistamines to relieve itching and topical gels;
• vitamin and mineral complexes, adaptogens.

In the presence of concomitant signs of depressive disorders (for example, when large areas of the body are affected), antidepressants may be required. Sometimes we can recommend sedatives, as well as sleeping pills, if people are not sleeping well due to itching and anxiety. If the inflammation is acute, the skin is severely affected, a short course of corticosteroids may be needed, but strictly under the supervision of a doctor to prevent side effects.

Some features of treatment depend on the type of lichen. With ringworm, shaving off the hair in the affected area is highly recommended, especially against the background of large bald spots that have appeared. This will help to treat the skin more effectively and quickly eliminate the fungus. If the stain is the only one, the hair can be carefully cut around, but if there are a lot of them, it is better to remove them all.

If this is a treatment for lichen planus, in addition to all the above measures, the use of anti-malaria drugs, drugs from the retinoid groups may be recommended. They have shown their effectiveness.

If it is herpes zoster, it is important to complete the full course of Acyclovir, as well as additionally use painkillers and antiplatelet agents that prevent platelets from sticking together. It is equally important to consult an immunologist, prescribe drugs to stimulate the immune system.

Prevention of lichen in humans

The basis of lichen prevention is a healthy lifestyle. In addition, you need constant monitoring of the condition of the skin – a daily shower or bath, the use of delicate hygiene products, the immediate treatment of all minor injuries and wounds. For infectious forms, depriving the basis of prevention is the separation of contacts with the sick.

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