Lichen planus (LP) is a fairly common skin disease that usually develops against a background of chronic systemic he alth disorders. Often, the pathology accompanies diabetes or is combined with ulcerative processes in the gastrointestinal tract, cirrhosis, gastritis. This combination is a key feature of LP, which distinguishes it from other dermatoses.
Where did the trouble come from?
Lichen planus appears if a person has a reduced immune status. A variety of factors can provoke the disease, from stressful situations to injuries, as well as metabolic disorders, hormonal imbalances. Against the background of such exposure, skin cells become more susceptible to pathogenic agents.
Exploring lichen planus and other dermatoses, experts have found that such diseases are largely associated with a genetic factor. It is believed that the predisposition to LP is inherited. Family history of the disease is known. The most likely to get sick if in the second,the third knee had patients with LP.
Currently, there are three main causes of LP. The first and most significant is infection. Lichen planus can develop against the background of exposure to drugs and chemical compounds - professional, household. Finally, the third reason is the active substances produced by the human body in a stressful situation, as well as compounds secreted by cells under the influence of pathogenic agents. Specific components produced by the internal organs under the influence of the disease are another type of the third cause of LP.
Types and species
Lichen planus, coded in ICD 10 code L43, most often appears in a typical form. These are polygonal pinkish plaques with a lilac undertone. The form is called typical. In addition to her, there are:
- atrophy;
- bullous;
- hypertrophy;
- erythema.
With hypertrophy, the disease manifests itself as large nodes, plaques, the surface of which is similar to warts. Atrophy is characterized by the presence of hyperpigmentation or the absence of color at all. Lichen planus in the mouth, on other mucous membranes, in other parts of the body may appear in the form of bubbles under the skin. If the disease is common, and its most striking feature is skin hyperemia, an erythematous form is diagnosed. An erosive form of lichen planus is possible - as the name implies, with such damage to the mucous membranes, erosion develops.
Based on the course, the case is classified as acute, subacute, prolonged. The first one includessituations when a person is sick for no more than a month, the second option - no more than six months. Prolonged LP is an option when the diagnosis persists for six months or more.
How to notice?
Most often it is possible to identify lichen planus in the mouth. Violation of the integrity of the mucosa is usually expressed by skin rashes, although isolated foci are possible. LP manifests itself as plaques, blisters, ulcers, red lesions.
Almost 20% of those suffering from the disease experience damage to the nail plate. This is possible with all types and forms. More often, from their own experience, they know what lichen planus looks like on the nails, those whose disease occurs in an erosive-ulcerative form or is accompanied by a blistering rash. Under the influence of the processes inherent in CPL, the plates lose their he althy shape, bumps, scallops, grooves appear, and a crack forms in the center. Over time, the plate becomes thinner, may disappear completely.
Skin areas where rashes are localized are disturbed by severe itching.
Clarification of the diagnosis
If you suspect lichen planus on the body, you should consult a doctor. The case will be handled by a dermatologist. There are usually no difficulties in making a diagnosis, since the polygonal plaques characteristic of LP are difficult to confuse with manifestations of other diseases. In addition, skin lesions usually have a specific color, a smooth upper layer with characteristic impressions - already on the basis of the first examination, the doctor can make an accurate diagnosis.
If pathological formationsmultiple, they are often grouped. Lichen planus in children and adults is usually localized on surfaces that a person often bends - elbows, forearms, shins, armpits. Also, quite often, the disease is detected on the organs of the reproductive system, in the lower abdomen, on the surface of the lower back, on the hips from the inside.
When in doubt, skin samples are taken from the patient for biopsy. Based on this analysis, it is possible to say exactly which type of lichen planus is disturbing in a particular case.
What to do?
Based on the symptoms, the treatment for lichen planus is chosen by the doctor. At the same time, they analyze the conditions under which the disease manifested itself. First of all, it is necessary to exclude the influence of all risk factors associated with everyday life, working conditions. If there are concomitant diseases, the doctor will recommend what tests you need to undergo to clarify them, which doctor to contact to draw up a therapeutic program to cure the problem. When infectious foci are identified, the doctor, taking into account the etiology of lichen planus, will first prescribe funds to stop the activity of this area, only after that he will begin to eliminate the consequences, that is, LP.
After the diagnosis is clarified, the patient is prescribed procedures for the sanitation of the oral mucosa. Prosthetics are recommended as needed. The diet for lichen planus obliges to refuse any products that irritate organic tissues. When choosing a program, analyze whichmedicines the person used shortly before LP and during the period of illness - they may also have to be abandoned.
Drugs and approaches
Based on the cause, lichen planus may be recommended to be treated with hormonal drugs, metabolic boosters, or other medications. Among the hormonal substances most often used are based on the products of processing of 4-aminoquinoline.
If the disease is accompanied by severe itching of individual skin areas, you can use antidepressants, sedatives, normalizing sleep and relieving the severity of manifestations. It is allowed to use means to eliminate an allergic reaction. Of the popular pharmacy names, it is worth noting Tavegil and Claritin. As a rule, when prescribing these drugs, the doctor will immediately report the possible negative consequences of taking them.
What else will help?
If the cause of lichen planus is metabolic disorders, the doctor prescribes multivitamin complexes to combat the disease. The choice in favor of a particular option is based on the characteristics of a particular case.
Retinol (vitamin A) stimulates regenerative processes, activating cell division. For adult patients, it is recommended to consume 100,000 IU per day. Derivatives of this compound inhibit inflammatory processes, normalize cellular regeneration. They show the greatest effect if the disease is localized in the mouth, the rim of the lips is affected. For a day appoint 25-50 mg. The duration of the therapeutic program is up to three weeks. Forto maintain the strength of the body, you can use carotenoids - good analogues of retinol.
With complex hormonal treatment of LP, alpha-tocopherol acetate is indispensable. This vitamin allows you to lower the dosage of hormonal drugs and shorten the duration of the cycle.
Some Features
If the pathology is prone to relapse, it is necessary to use means that stimulate the supply of oxygen to the tissues. The medicines "Actovegin" and "Cyto-Mak" have proven themselves well.
Ointment from lichen planus in humans is an important element of the therapeutic course. In addition to ointments, solutions, gels are used. The preparations are applied by application. Mostly remedies for KPL are produced with menthol, lemon extracts, antihistamines and painkillers. External treatment can relieve itching. Folk remedies for the treatment of lichen planus are also aimed at the same.
If the plaques have grown very large, it is necessary to use liquid nitrogen or a laser to remove them. Modern technologies make it possible to destroy formations with minimal harm to he althy tissues. Foci of ulceration are treated with regenerative preparations to activate tissue repair at the cellular level. Sea buckthorn oil, rosehip oil, Solcoseryl ointment and gel come to the aid of the sick.
In some cases, the doctor recommends a course of ultraviolet irradiation. Well-established drugs that affect the immunepatient status. In particular, intramuscular injections of the drug "Neovir" are prescribed. The duration of the program is five introductions. For a shorter course (4 injections), you can use the drug "Ridostin".
Disease: sometimes so different
Most often, LP is a chronic dermatosis, which is characterized by a single papule. Doctors say that, on average, LP is diagnosed in 2.5% of the total number of human skin diseases. Among disorders of the he alth and integrity of the oral mucosa, LP is much more common - its prevalence is estimated at 35%. In recent years, the frequency of occurrence has increased significantly. Doctors have roughly calculated that almost 4% of the world's population at least once in their lives are forced to face the CPL. There is a risk of developing the disease in people of various age groups. More often LP is diagnosed in women than in the stronger sex.
The mucous membranes of the mouth with lichen are affected more often in people of the age group of 50-60 years. But skin rashes are more typical for people aged 40-45 years. Among children, the prevalence of LP is quite low - much lower than in adults.
Don't miss it
Although LP presents with a variety of symptoms, all cases are united by monomorphic rashes. The diameter of the papules formed during the disease usually does not exceed 5 mm. In the center, the papule is retracted, has a shiny surface. To see the nodules, you need to look at the formation with side lighting - this is how they are best seen.
Skin peeling is possible with LP, but the severitythey are small. The separation of scales is difficult. In some cases, peeling resembles the clinical picture of psoriasis - this is the basis for diagnosing a specific form, in medicine called psoriasiform lichen.
More often rashes - multiple grouped nodules that form stripes, garlands. Sometimes the formations are arranged in circles. When merged, plaques are obtained. Over time, new rashes appear around such an area. When the nodule resolves, a reddish tint persists for a long time on this area of skin.
What to look out for?
With LP, the diseased areas of the skin are constantly disturbed by severe itching. Without medical assistance, a person practically cannot sleep at night, which sooner or later leads to a malfunction of the nervous system. The strongest sensations are associated with seals localized on the fingers. Focusing on such signs, often the inhabitants are often convinced in LP that scabies needs to be treated.
Parts of the head covered with vegetation, feet, hands, face for LP rarely become foci of localization. The face, the part of the head covered with hair, on average, is affected in one out of ten patients. Manifestations of the disease in this case are seals that have a pronounced dark shade of red. The areas are disturbed by severe itching. Over time, the disease progresses, leading to hair loss.
Almost every fourth person suffering from LP on the mucous membranes does not experience manifestations of this disease on the skin. In addition to the oral cavitythe disease is localized in the vestibule of the vagina, on the head of the male genital organ. The nodules on the mucous membranes are grayish in color. If the disease covers the tongue, flat formations with jagged edges appear here. On the lips, KPL manifests itself as purple plaques. On the upper side, slight peeling is possible.
Stages and features
If LP develops in women, and the area of localization is the reproductive system, there is a risk of a decrease in the passage of the urethra, which negatively affects the ability to empty the bladder. Often in this case, LP provokes pain during intimate contact. Against the background of the disease, the inguinal region is itchy, irritated.
You can notice the CPL by the so-called Wickham grid. This term refers to a symptom that manifests itself on the surface of large formations - these areas from above seem to be covered with a thin mesh. If vegetable oil is applied to the affected area, the grid can be seen especially clearly.
When exacerbated, the appearance of the Koebner phenomenon is possible. The term refers to a condition in which new formations are localized in the areas affected by any injury.
Features of some types of KPL
If the LP is manifested by warts, the form is characterized by stratification, the surface of the formations is bumpy. Numerous nodules are present around the large plaque. This form is more often observed on the shins, but it can spread to the face, upper limbs. To some extent, the manifestations are similar to basiloma, keratosis.
When an open skin area is affected, the head in the part wherehair, sclerotic changes, atrophy are observed, which gave the name to the form of LP. Baldness occurs in small patches.
If the disease is accompanied by the formation of subcutaneous papules, inside such formations usually contain a serous substance. There is a possibility of blood inclusion. Bubbles are localized both on he althy areas of the skin, and on plaques, papules. Additionally, LP may be accompanied by a rash. More often this form of the disease is localized on the lower extremities. If the blisters are large, the bullous type of LP is diagnosed.
Moniliform KPL is a rash, the elements of which are similar in shine to wax. Usually they form a kind of "necklace". More often this type of LP is localized in the lower abdomen and on the hips, elbows, forehead, and neck. Possible ear damage.
What else are there?
KLP can be diagnosed in a pointed form. More often this type is localized on the lower extremities, it is possible to damage the neck, shoulder blades. In this case, a rash is formed from papules of a specific shape. There is a fat in the center of the formation - hyperkeratosis.
With the pigment type, the rash is accompanied by the appearance of brownish areas of increased pigmentation on the skin. Nodules characteristic of LP are usually colored in a dark shade of brown. In some cases, spots appear before rashes.
Possible ring-shaped KPL. The rashes form circles or halves of circles. The disease is more common in men, usually localized in the reproductive system or on the inner femoral surface.
Whenulcerative erosive form of LP is localized on the mucous membranes, mainly in the oral cavity. Organic tissues ulcerate, non-healing areas appear here for a long time, and the area around it swells, turns red. There are cases when such formations bothered the patient for years. Even after the complete disappearance of symptoms, there is a possibility of a relapse.
In a vanishingly small percentage of cases, LP develops in an obstructive form, erythematous, serpigious.
Science does not stand still
The reasons for the appearance of CLP are many and varied. To this day, specialists with a prominent world name are engaged in clarifying them. It was possible to identify a wide range of factors, but professionals are convinced that much remains to be learned. LP is a multi-causal disease that develops under the influence of endo- and exogenous factors.
In an impressive percentage of cases, the situation can be explained by the state of the nervous system. LP for the first time, relapse is more often observed against the background of severe mental, psychological, emotional trauma. Often, along with LP, vegetative neurosis or neurasthenia is diagnosed. Other mental deviations and disturbances are possible. With neuritis, the rashes characteristic of LP, in the predominant percentage of cases, are localized along the branches of the nervous system.
It is believed that LP is provoked by a pathogenic microscopic form of life that exists for a long time in the cells of the human epidermis. If the situation develops in such a way that several factors influence simultaneously, there is an acutestage against the background of a weakened immune defense. This theory has not only supporters, but also opponents, so it needs to be improved.
KLP is possible with autointoxication. This is observed if the functionality of the liver, gastric system or intestinal tract is impaired. Sometimes lichen accompanies diseases of the heart and blood vessels.
