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Lichen planus in humans – This is a dermatosis of a chronic course, 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 differently.
Statistics indicate that in the total mass of all dermatological diseases, lichen red 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 cases of this type of lichen in recent years. According to available data, from 0,1% to 4% of people will suffer this ringworm at least once in their lives. 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, in them it is detected extremely rarely.
Symptoms of red lichen
Symptoms of lichen planus are varied, 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 red-violet, or raspberry-red. The center of the papule is retracted, their surface shines. Nodules are especially clearly visible in side lighting.
Peeling, as a rule, is not too pronounced. Scales can be separated with difficulty. Sometimes peeling resembles a picture of psoriasis. In this case, we are talking about a psoriasiform variety of the disease.
Multiple rashes predominate, when the nodules are located in groups. They can be combined into garlands, stripes, circles, they can merge, forming plaques. Around these mergers, elements of the rash are again formed. After the nodules resolve, a zone 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. The seals that are localized on the fingers itch the most. Therefore, many people mistakenly perceive lichen for scabies. (read also: Scabies – causes and symptoms)
A favorite place for the localization of rashes are the elbows, knees, inner thighs, groin, armpits, human torso and oral mucosa. It is possible to include the 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 the development of inflammation caused by lichen planus. However, in about 10% of people, the pathology captures the head with its scalp and face. In this case, the lichen has the appearance of a dark red seal, which itches a lot. As the pathology progresses, hair begins to fall out of the head.
In 25% of people who have lichen 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, a grid. 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 with localization in the genital area can lead to narrowing of the urethra and disrupt the process of emptying the bladder. Often, lichen becomes the cause of pain that occurs during intimacy, can cause irritation and itching in the perineum.
Wickham’s grid symptom is another characteristic sign of the disease. It manifests itself in the fact that a pattern in the form of a grid is formed on the surface of large papules. It can be visualized especially well if vegetable oil is applied to the papules.
The Koebner 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 in 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 somewhat different in one way or another.
So, the symptoms of red lichen in its various forms will be as follows:
For hypertrophic, or, as it is also called, the warty form of lichen, the appearance of tuberous layers is characteristic. Their color can be purple or brownish red. 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 basalioma.
When lichen develops on an open area of the skin, or on the scalp, where atrophic and sclerotic changes are already occurring, 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 vesicular 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 of lichen planus appears on the dermis. The vesicular form of the disease most often affects the lower 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, which has a waxy sheen on top. The elements of the rash themselves form into a necklace. The priority places for such rashes are: ears, neck, forehead, elbows, buttocks, abdomen.
The pointed form of the disease is characterized by the appearance of rash elements in the form of pointed papules on the lower extremities, shoulder blades and neck. In the middle of each formation there is a horny fat, which is an area of hyperkeratosis.
The pigmented form of the disease manifests itself 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 dark brown nodules. There may be spots before the rash appears.
Ring-shaped form of the disease. 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-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 mucous membrane surrounding them swells, turns red. Sometimes such rashes can exist for years, and after their disappearance there is a high risk of recurrence.
It is extremely rare for people to be diagnosed with an erythematous, serpigio, and obtous form of the disease.
Causes of red lichen
Although many scientists have been and continue to be engaged in establishing the cause of the appearance of lichen planus, nevertheless, it still remains not fully elucidated. Therefore, modern researchers call lichen planus a multi-causal 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 reason. 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 detected in parallel. It has been established 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 pathogen that causes lichen planus simply exists in human epidermal cells for a long time. Under the influence of certain factors that weaken the immune system, it is activated and causes an acute stage of the disease.
Transmission of the disease by inheritance. Adherents of this theory of the development of the disease indicate that in 0,8-1,2% of patients the occurrence of lichen planus in several generations was confirmed. Moreover, the disease often manifested in childhood and proceeded with constant relapses.
Taking certain medications.
Autointoxication of the body with the accumulation of excessive amounts of toxins in it. These processes can be associated with liver diseases, for example, with cirrhosis or hepatitis, with gastrointestinal diseases (ulcers, gastritis), with endocrine diseases (diabetes mellitus), with pathologies of the heart and blood vessels.
immunoallergic theory. It explains the mechanism of the development of the disease, starting from disturbances in the functioning of the immune system. At the same time, the body’s immunity perceives its own skin cells as foreign and begins to destroy them with the help of antibodies, leukocytes, immunoglobulins, etc. Due to such pathological activity of immunity, substances leading 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 also confirmed by the fact that patients with lichen planus are often found to 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 are mechanical damage to the skin. For example, in places of constant friction with clothes or jewelry.
Kebner reaction. The occurrence of lichen ulcers in the oral cavity may be associated with a traumatic effect on it by the sharp edges of existing or partially missing teeth, improperly installed dentures, biting the cheeks.
Studies have been conducted that have been limited to long-term follow-up 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.
The disease may be associated with allergies, as evidenced by the available clinical studies. This is especially true for diseases that affect the oral cavity. Often an allergic reaction occurs to the components that make up dentures or fillings, or to the components of toothpaste (this is especially true for cinnamic acid). Sometimes it is enough just to eliminate the existing allergen to get rid of the disease.
Can lichen planus be caused by drugs?
Red lichen can be caused by taking medications, however, this happens quite infrequently. Danger in this regard are 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, antibacterial agents can provoke the disease. tetracycline groups and sulfonylurea derivatives.
Is lichen planus dangerous? Consequences and complications
Although in most cases, lichen planus does not pose a serious threat to human health, however, sometimes it can provoke serious complications, including:
Temporary darkening of the skin areas where the foci of inflammation were located.
Formation of scars and depressions on the skin.
Hair loss without the possibility of their subsequent restoration.
The occurrence 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).
Pronounced 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 immediately seek medical help.
Diagnosis of red lichen
Diagnosis of lichen planus by a dermatologist does not cause difficulty 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 history taking. 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. On the basis of the histological examination of the biopsy, it will be possible to judge the presence of hyperkeratosis, inflammatory reaction, hypergranulosis, degeneration of the epidermal layer and its infiltration, and the presence of colloidal Sevatt bodies.
If there are suspicions about the presence of lichen planus in the nasal cavity or in the esophagus, then it is possible to prescribe FGDS 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 a contagious disease, it is not transmitted from person to person. However, hepatitis C may be a factor influencing the development of lichen. In turn, hepatitis C is a contagious disease, so if you have symptoms of dermatological diseases, you need to see a doctor.
How and for how long does lichen planus pass? Can it be chronic? Can it re-evolve? After the first appearance on the skin, lichen planus can remain on them from six months to 2 years. After this time, the deprive passes. However, the risk of recurrence has not been excluded. When 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 seaside 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 – radiation red lichen. But this variety is found only among the inhabitants of India, Africa and the Middle East. However, doctors still do not recommend abusing sunburn, as in this case there is a risk of developing skin cancer (not associated with lichen).
Can I shower or take a bath with lichen planus? You can wash in the shower and take a bath without any fear. These water procedures do not affect the development of the disease.
How can lichen planus affect the development of pregnancy? There are no data on the effect of lichen planus on the course of pregnancy. However, if there is a fact of the disease, a visit to the doctor is necessary.
How to treat lichen planus?
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 functioning of the nervous system;
Ointments for local treatment.
Therapy is usually prescription drugs, treatment can only be prescribed by a doctor.
Auxiliary methods of treatment of lichen planus are physiotherapy techniques: PUVA therapy, laser therapy, magnetotherapy.
No less important is the treatment of concomitant diseases: diabetes mellitus, hypertension, liver and gastrointestinal diseases. Particular attention should be paid to the relief of patients from nervous disorders. Perhaps the appointment of sedatives, vitamin therapy.