Lichen – a chronic skin disease of unknown origin

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Lichen is a chronic skin disease. It manifests as papular, vesicular or pigmented lesions on the skin or mucous membranes. The causes of lichen are not fully known – the disease takes various forms (lichen planus, lichen sclerosus) and its development is fostered by various factors, including autoimmune factors. How does impetigo manifest itself and how to treat it?

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Impetigo is a bacterial disease that causes an inflammatory process in the epidermis or dermis. Blisters may develop in the course of the disease (blistering impetigo), but blister-free impetigo is also seen. The following types of impetigo can be distinguished:

1. newborn bullous impetigo – caused by a staphylococcal infection, manifests itself in the first weeks of a newborn’s life and manifests as blisters and purulent blisters on the skin;
2. impetigo is contagious – it’s caused by bacteria Streptococcus pyogenes (purulent streptococcus) and Staphylococcus aaureus (Staphylococcus aureus); an infected person usually develops purulent bullous lesions on the face (around the nose and mouth) and on the nails, but there are also infections without blisters.

Lichen sclerosus – genital and extra-genital

One of the types of lichen is lichen sclerosus, which often affects the genitals and anus, but sometimes (in about 15-20% of cases) it takes the extra-genital form and is observed in other parts of the body, e.g. on the trunk, neck, shoulders, thighs, buttocks. This type of lichen is inflammatory and can affect the skin as well as mucous membranes. It can occur in women and men, but is more often diagnosed in women. Symptoms indicative of lichen sclerosus have:

1. itching;
2. flat spots (single or diffuse);
3. whitish papules (shade of porcelain or ivory);
4. telangiectasias and keratin plugs – possible at an advanced stage of the disease;
5. scarring;
6. Koebner symptom – the appearance of lumps along the scratch line;
7. in the case of the genital form also: changes with erythema, erosions, skin atrophy.

It is not known exactly what causes lichen sclerosus. It is suspected of having a genetic or autoimmune background, and may also be caused by infections and hormonal disorders. In treat lichen sclerosus strong glucocorticosteroids (ointments, creams, injections), hormone therapy, retinoids and local calcineurin inhibitors are used. Other forms of therapy are also used, including phototherapy and dynamic phototherapy (PDT), as well as surgical methods. Extra-genital lichen sclerosus is more difficult to treat.

1. Also read: Lichen in a child – types, causes, appearance, treatment

Lichen planus – types and possible causes of the disease

Lichen planus, also known as red lichen, is inflammatory and often chronic. It usually affects the skin (including the scalp), mucous membranes and the nail plate. As in the case of lichen sclerosus, also the flat form of the disease has only a partially understood etiology – it is probably related to the autoimmune reaction of the body, as well as to HCV infection. A skin condition of this nature can also indicate an allergic reaction to treatment with pharmaceuticals, including medications for malaria, diabetes, and high blood pressure. Amalgam fillings may also be responsible for the problem.

Due to the heterogeneous nature of the disease, it stands out different clinical varieties of lichen planus:

1. lichen planus pigmentosa – skin lesions are dark in color (purple, gray-brown, brown) and have a characteristic layout, as they appear in the bends of the limbs, along the Blaschko line or along the veins of the lower extremities;
2. blistering lichen – in this form of the disease, fluid-filled blisters appear on the skin of the lower extremities;
3. ringworm – this is a fairly commonly recognized type of lichen planus that affects the skin or mucous membranes; examples of occurrence are the limbs, torso and genital area;
4. papillary lichen planus – also known as hypertrophic, forms hard inflammatory lesions; chronic papillary lichen is associated with an increased risk of developing squamous cell carcinoma;
5. lichen planus atrophic – can occur with other forms of the disease, is in the form of oval-shaped discs or lumps, with a visible disappearance of the central part of the lesions;
6. follicular lichen planus – this type of disease is characteristic of hairy skin, so lichen appears mainly on the head, armpits and in the groin area;
7. lichen planus linear – the form of lichen that typically appears in adolescents and children, skin lesions resemble those found in shingles;
8. inverted lichen planus – appears under the breasts, in the bends of the limbs, armpits or groin, it may be accompanied by erosions, discoloration and keratinized nodules;
9. ulcerative lichen planus – most often seen on the feet, also rarely near the anus and on the trunk, the lesions are milky in color and cause pain;
10. erythrodermic lichen planus – according to the available data, this form of the disease is not common; it causes general weakness, severe itching, and the eruptions infiltrate, have the form of blisters, erythematous foci and papules;
11. lichen planus in the form of a pemphigoid – the disease combines the features of lichen and bullous pemphigoid, the blisters are usually located on the arms and legs;
12. Lichen actinicus – this form of the disease is caused by UV rays, so it mainly appears in spring and summer, and is also called tropical lichen.

Prophylactically and as an auxiliary in the treatment of impetigo, use Bioherba’s AHA and BHA acid peeling for home use, which soothes skin lesions, accelerates skin regeneration and deeply nourishes it.

Lichen planus – treatment

The treatments used to treat lichen planus are similar to those of lichen sclerosus – glucocorticosteroids (classes III and IV) are the gold standard. Topical treatments with ointments, including calcineurin inhibitors, are used whenever possible. Cyclosprin and retinoids are also effective in treating lichen planus. If the physician deems the local treatment insufficient, general treatment is initiated. Some forms of lichen can be treated with UVA, UVA, UVB and PUVA.

Treatment of lichen requires constant consultation with a doctor. If you cannot go to the clinic, make an online teleconsultation with a dermatologist. You can do it quickly and safely at haloDoctor.pl. Take advantage of the visit without leaving your home.

As an aid in treating lichen and skin care, use Natural Tar soap, which has anti-inflammatory properties and does not cause irritation.

Other types of lichen

The term lichen may also refer to a medical condition other than those listed above. An example would be lichen chronic ordinary (restricted neurodermatitis), which is considered a mild form of AD. It may resemble hypertrophic lichen planus, so more detailed diagnosis is needed to distinguish between these two disease entities.

Very rarely is observed in patients too amyloid lichen. It appears in the MEN2 syndrome, with the mutation of the RET gene and the 10q11.2 chromosome. Amyloid lichen must be distinguished from lichen planus. An interesting example of impetigo is also lichen gold, which has the form of coppery-brown spots with golden rims – it is most often seen in younger people and children.

It is also worth mentioning Fr. lupus erythematosus, an autoimmune disease that can accompany lichen planus. Lupus erythematosus is commonly known as systemic lupus erythematosus. One of the hallmarks of this condition is butterfly-shaped facial erythema.

You can take advantage of a dermatological consultation as part of a visit to the National Health Fund. A private visit to a dermatologist can cost around PLN 100–200.