Red lichen planus (CPL) is a fairly common skin disease, usually developing against a background of chronic systemic health problems. Often, pathology accompanies diabetes or is combined with ulcerative processes in the digestive tract, cirrhosis, and gastritis. This combination is a key feature of the CPL, distinguishing it against the background of other dermatoses.
Where did the trouble come from?
Lichen planus appears if a person has a lowered 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 this effect, skin cells become more susceptible to pathogenic agents.
Examining lichen planus and other dermatoses, experts found that such diseases are largely associated with a genetic factor. It is believed that a predisposition to KPL is inherited. Family history of the disease is known. Most likely to get sick if in the second, third knee were patients with CPL.
Currently, there are three main causes of CPL. The first and most significant is infection. Red lichen planus may develop amid exposure to drugs and chemical compounds - professional, domestic. 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. The specific components produced by internal organs under the influence of the disease are another variation of the third cause of CPL.
Types and Types
Red lichen planus, in ICD 10 encoded with the L43 code, most often appears in a typical form. This is a polygonal pinkish plaque with a purple subtona. The form is called typical. In addition to her, there are:
- atrophy;
- bullous;
- hypertrophy;
- erythema.
With hypertrophy, the disease manifests itself in 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 vesicles under the skin. If the disease is common, and its most striking feature is skin hyperemia, the 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 considered acute, subacute, prolonged. The first includes situations when a person is sick for no more than a month, the second option - no more than six months. Long CPL 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. KPL manifests itself as plaques, blisters, ulcers, red foci.
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 on the nails looks like, those who have an erosive-ulcerative disease or are accompanied by a vesicle rash. Under the influence of the inherent CPL processes, the plates lose their healthy shape, tubercles, scallops, grooves appear, and a crack forms in the center. Over time, the plate becomes thinner, it can disappear completely.
Skin areas on which rashes are localized are severely itchy.
Diagnosis
If red lichen planus is suspected on the body, consult a doctor. The case will be dealt with by a dermatologist. There is usually no difficulty in making a diagnosis, since the polygonal plaques characteristic of CPL are difficult to confuse with the manifestations of other diseases. In addition, skin lesions usually have a specific color, a smooth top layer with characteristic impressions - already on the basis of the first examination, the doctor can make an accurate diagnosis.
If pathological formations are multiple, they are more often grouped. Lichen planus in children and adults is usually localized on surfaces that a person often bends - elbows, forearms, lower legs, axillary fossae. 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.
If in doubt, skin samples are taken from the patient for biopsy. Based on this analysis, it can be said exactly what kind of lichen planus bothers in a particular case.
What to do?
Based on the symptoms, the doctor chooses the treatment for lichen planus. In this case, they analyze under what conditions the disease has 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 go through to clarify them, which doctor to seek a therapeutic program to cure the problem. When identifying infectious foci, the doctor, given the etiology of lichen planus, will first prescribe funds to stop the activity of this area, only after that it will begin to eliminate the consequences, that is, CPL.
After clarifying the diagnosis, the patient is prescribed procedures for sanitation of the oral mucosa. As necessary, it is recommended to do prosthetics. A diet with lichen planus obliges to refuse any products that irritate organic tissues. When choosing a program, they analyze what medicines a person used shortly before the CPL and during the period of the illness - they may also have to be abandoned.
Drugs and Approaches
Based on the causes, lichen planus may be recommended to be treated with hormonal drugs, metabolic stimulants, or other medicines. Among hormones, substances based on products of the processing of 4-aminoquinoline are most often used.
If the disease is accompanied by severe itching of individual skin areas, you can use antidepressants, sedatives, normalize sleep and relieve manifestations. Allowed the use of funds to eliminate an allergic reaction. Of the popular pharmacy names, it is worth noting Tavegil and Claritin. As a rule, prescribing these funds, the doctor will immediately report on the possible negative consequences of taking.
What else will help?
If the cause of lichen planus is a metabolic disorder, the doctor prescribes multivitamin complexes to fight the disease. The choice in favor of a particular option is based on the 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 border of the lips has suffered. For a day, 25-50 mg are prescribed. The duration of the therapeutic program is up to three weeks. To maintain the strength of the body, you can use caroteniodes - good analogues of retinol.
With complex hormonal treatment of CPL, alpha alpha-tocopherol acetate is indispensable. This vitamin allows you to lower the dosage of hormonal drugs and reduce the duration of the course.
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-Mac have proven themselves well.
Ointment for lichen planus in humans is an important element of the therapeutic course. In addition to ointments, apply solutions, gels. Preparations are applied. Mostly, KPL drugs are released with menthol, lemon extracts, antihistamines and painkillers. External treatment can relieve itching. The folk remedies for lichen planus are also aimed at the same.
If the plaques have grown very large, you must use liquid nitrogen or a laser to remove them. Modern technology allows you to destroy the formation with minimal harm to healthy tissues. Foci of ulceration are treated with regenerative drugs to activate tissue repair at the cellular level. Sea buckthorn, rosehip oil, ointment and Solcoseryl gel come to the aid of patients.
In some cases, the doctor recommends a course of ultraviolet radiation. Well-proven drugs that affect the immune status of the patient. In particular, injections of the Neovir preparation are prescribed intramuscularly. The duration of the program is five introductions. A shorter course (4 injections) can use the drug "Ridostin."
Disease: sometimes so different!
More often, CPL is a chronic dermatosis, which is characterized by a single papule. Doctors say that on average, CPL is diagnosed in 2.5% of the total number of human skin diseases. Among disorders of the health and integrity of the oral mucosa, CPL is much more common - its prevalence is estimated at 35%. In recent years, the frequency of occurrence has increased significantly. Doctors have roughly estimated that almost 4% of the world's population is forced to encounter CPL at least once in their lives. There is a risk of developing the disease in people of different age groups. More often, CPL is diagnosed in women than in men.
Mucous membranes of the mouth with lichen are more often affected in people of the age group of 50-60 years. But skin rashes are more characteristic of people aged 40-45 years. Among children, the prevalence of CPL is quite small - much lower than in adults.
Do not miss!
Although CPL is manifested by a variety of symptoms, all cases are combined by monomorphic rashes. The diameter of papules formed during illness usually does not exceed 5 mm. In the center, the papule is pulled in, has a shiny surface. To see the nodules, you need to look at the formation in side lighting - so they are best seen.
With CPL, skin peeling is possible, but their severity is small. The separation of the scales is difficult. In some cases, peeling resembles the clinical picture of psoriasis - this is the basis for the diagnosis of a specific form, in medicine called psoriasis versicolor.
More often, rashes are multiple grouped nodules that form stripes, garlands. Sometimes formations are arranged in circles. When merged, plaques are obtained. Around this area, new rashes appear over time. When the nodule is resolved, a reddish hue remains in this area of the skin for a long time.
What to look for?
With CPL, diseased skin areas are constantly disturbed by severe itching. Without medical assistance, a person can hardly sleep at night, which sooner or later leads to a failure of the nervous system. The strongest sensations are associated with localized seals on the fingers. Focusing on such signs, often the townsfolk often with CPL are convinced that scabies should be treated.
Parts of the head covered with vegetation, feet, hands, faces for CPL rarely become foci of localization. A person with a hairy part of the head is affected on average in one out of ten patients. The manifestations of the disease in this case are seals that have a pronounced dark shade of red. The sites are disturbed by severe itching. Over time, the disease progresses, leading to hair loss.
Almost every fourth person suffering from CPL on the mucous membranes does not experience manifestations of this disease on the skin. In addition to the oral cavity, the disease is localized on the eve of the vagina, on the head of the male genital organ. 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 of the CPL manifests itself as purple plaques. On the upper side, slight peeling is possible.
Stages and Features
If CPL develops in women, and the localization area is the reproductive system, there is a risk of reducing the passage of the urethra, which negatively affects the possibility of emptying the bladder. Often in this case, the CPL provokes pain during intimate contact. Against the background of the disease, the inguinal region is itchy, irritated.
KPL can be seen on the so-called Wickham grid. This term refers to a symptom that appears on the surface of large formations - these areas from above seem to be covered with a thin net. If you apply vegetable oil to the affected area, the mesh can be seen especially clearly.
With exacerbation, the appearance of the Kebner phenomenon is possible. The term refers to a condition in which new formations are localized in areas affected by any trauma.
Features of some types of KPL
If the CPL is manifested by warts, the form is characterized by layering, the surface of the formations is tuberous. Around the large plaque there are numerous nodules. This form is more often observed on the legs, but it can spread to the face, upper limbs. To some extent, the manifestations are similar to basiloma, keratosis.
With damage to the open skin area, head in the part where the hair grows, sclerotic changes, atrophy are observed, which gave the name the form of the CPL. 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 chance of turning on the blood. The vesicles are localized on healthy areas of the skin, and on plaques, papules. Additionally, CPL may be accompanied by a rash. More often this form of the disease is localized on the lower extremities. If the bubbles are large, a bullous type of CPL is diagnosed.
Moniliform CPL is a rash whose elements are similar in brightness to wax. Usually they make up a kind of “necklace”. More often this type of CPL is located in the lower abdomen and on the hips, elbows, forehead, and neck. Ear damage possible.
What else are there?
CPL can be diagnosed in peaked form. More often this type is localized on the lower extremities, it is possible damage to the neck and shoulder blades. In this case, a rash from papules of a specific form is formed. At the center of the formation there is speck - hyperkeratosis.
With the pigment type, the rash is accompanied by the appearance on the skin of brownish areas of increased pigmentation. The nodules characteristic of the CPL are usually colored in a dark shade of brown. In some cases, spots appear before the rashes.
Possible annular form of the CPL. Rashes form circles or half circles. The disease is more often observed in men, usually localized in the organs of the reproductive system or on the inner femoral surface.
With an ulcerative erosive form, the CPL is localized on the mucous membranes, mainly in the oral cavity. Organic tissues ulcerate, nonhealing areas appear here for a long time, and the area around it swells, turns red. There are cases when such formations have bothered the patient for years. Even after the symptoms disappear completely, there is a chance of relapse.
In a vanishingly small percentage of cases, CPL develops in obtuse, erythematous, and serpigiotic form.
Science does not stand still
The causes of the appearance of CPL are numerous and varied. To this day, specialists with a prominent world name are engaged in their refinement. It was possible to identify a wide range of factors, but professionals are convinced that much remains to be learned. CPL is a multi-cause disease that forms under the influence of endogenous, exogenous factors.
In an impressive percentage of cases, the situation can be explained by the state of the nervous system. CPL for the first time, relapse is more often observed against a background of severe mental, psychological, emotional trauma. Often, along with CPL, vegetoneurosis or neurasthenia is diagnosed. Other mental abnormalities and disorders are possible. In neuritis, the rashes characteristic of CPL are predominantly localized along branches of the nervous system.
There is an opinion that CPL is provoked by a pathogenic microscopic life form that has long existed in the cells of the human epidermis. If the situation is such that several factors influence at the same time, an acute stage is observed against the background of a weakened immune defense. , , .
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