Red lichen planus

Red lichen planus
Lichen planus is a dermatosis characterized by its chronic course. Its only element is the papule. Symptoms include lesions of the skin, nails, mucous membranes of the body. There are many clinical forms of lichen planus, which is due to the process of localization and grouping of papules. If a specialist discovers a complex form of lichen planus, a biopsy will be used to diagnose it.

The content of the article:
Causes of lichen planus
Classification of lichen planus
Symptoms of lichen planus
Diagnosis of lichen planus
Treatment of lichen planus
Red lichen planus
Treatment of lichen planus includes the use of antimalarial drugs, allergy medications, corticosteroids. Phototherapy is prescribed from hardware techniques.

This is a fairly rare disease in humans. Lichen planus occurs only in 2.5% of all dermatological cases diagnosed by specialists. However, in the situation of diseases of the oral mucosa, this percentage increases significantly, and, according to some data, it is 35% here. Today, experts state an increasing number of diseases of lichen planus, while women get sick more often than men.

Causes of lichen planus
The full range of causes of this disease has not yet been fully studied by doctors. Modern medicine notes that lichen planus is a multi-causal disease that can be triggered by a combination of the influence of various external and internal aspects. Lichen planus as an inadequate tissue reaction occurs as a response to disorders in the immune system and metabolism. Experts also note the importance of hereditary predisposition in the development of lichen planus.

Individual cases demonstrate that lichen planus can occur as a reaction to prolonged exposure to chemicals, including after taking medications (bismuth or tetracycline). Then the cause of the occurrence of lichen planus is fixed as a response to a chemical stimulus. The same reason is the most common for the occurrence of a separate red lichen planus on the mucous membrane of the oral surface.

The causes of lichen planus may also include the psychoneurotic spectrum. It is noted that stress, reflex-segmental therapy and hypnosis sessions can cause the disease. The causes of the disease also lie in the dysfunction of the gastrointestinal tract, pancreas, liver, violation of the general hormonal background of a person.

The mucous membrane of the mouth can be affected by red lichen planus in case of injury with dentures, sharp edges of teeth. Sometimes the oral cavity can be injured, on the contrary, by the absence of teeth.

Classification of lichen planus
Red lichen planus is divided into types, considering the symptoms of the disease. According to clinical manifestations , the disease has the following forms:

typical;
warty, or hypertrophic;
atrophic;
bubbly, or pemphigoid;
moniliform;
pigmented;
pointed;
ring – shaped;
erosive and ulcerative;
rare forms.
Symptoms of lichen planus
The most characteristic symptom of lichen planus is a monomorphic rash consisting of bubbles or papules. They differ in red-purple or crimson shades. The diameter of the elements of the monomorphic rash is about 2-5 millimeters. The structural characteristic of papules is a retracted middle, a waxy sheen on the surface. This is clearly noticeable, for example, when the rash is illuminated laterally. Peeling is insignificant or completely absent, the scales are hard to separate. Sometimes peeling is similar in nature to psoriatic. Then the psoriasiform variant of lichen planus is fixed.

This disease in most cases is characterized by multiple monomorphic rashes, located in groups. They also form some pattern, folding into lines, rings or garlands. Elements of a monomorphic rash tend to merge, after which plaques form, and new papules appear around them.

After the papule leaves the skin, an area of persistent hyperpigmentation remains in its place. Monomorphic rash with lichen erythematosus is accompanied by itching, tingling sensation, which causes neurotic anxiety and sleep disturbance in the patient.

The most frequent place of localization of groups of monomorphic rash are the areas of the skin that are most often subjected to flexion, for example, knees and elbows. In addition, the inner side of the thighs, armpits, inguinal region, and the mucous membrane of the mouth are susceptible to this disease. Nail changes may also be present, characteristic symptoms are scallops, cloudy nail plate, longitudinal stripes, destruction of the nail roller.

With lichen planus, the scalp, face, palms and soles rarely suffer from a rash.

Mucosal lesions, which are diagnosed in a quarter of patients with lichen planus, may not be accompanied by rashes throughout the body. But papules appear on other mucous membranes. For example, elements of a rash can be found on the vestibules of the vagina or glans penis. Grouping is not required, but it is possible. Experts note that the elements of a monomorphic rash form lace, rings or a mesh. Here the rash is gray, plaques with white edges appear on the tongue, purple nodules on the lips, the surface of which is peeling.

In addition, lichen planus is characterized by one common symptom, which is called the “Wickham Grid Symptom”. On large papules, a network-like pattern can be detected, most clearly visible after the rash is lubricated with sunflower oil.

Also, the acute form of lichen planus is characterized by the presence of the Kebner phenomenon. This is the process of formation of new papules in the place where the skin was injured.

The warty or hypertrophic form of lichen planus is characterized by hyperkeratosis — the formation of warty layers on the surface of the formed papules. New nodules appear around such layers. Localization of warty layers is located on the shins, sometimes on the upper limbs and face. The symptoms of a warty or hypertrophic form of lichen planus are often similar to senile keratosis or basal cell carcinoma.
The atrophic form of lichen planus is characterized by sclerotic lesions on the site of already burst rashes. Atrophic neoplasms can also develop there. In addition, the scalp may be prone to hair loss, manifesting as small foci of baldness.
The vesicular or pemphigoid form of lichen planus is marked by the formation of vesicles, inside which there is a serous-bloody content. Such bubbles can appear on the surface of papules and plaques, but they have a feature to spread to healthy skin. This type of rash is combined with monomorphic and is common for lichen planus. The elements are grouped more often on the patient’s shins and feet. With the formation of bubbles of a particularly large size, doctors state the bullous form of red lichen planus.
Monilimorphic red lichen planus is characterized by rashes with a pronounced waxy surface, forming a kind of necklace. Accordingly, such rashes are grouped mainly on the face, neck, behind the ears, and also on the hands, elbows, abdomen and buttocks. It is also characteristic of the symptom that the skin between the shoulder blades, on the nose and cheeks, the skin of the palms and soles of the patient remain intact and healthy.
The pigmented form of red lichen planus is marked by the appearance of brown pigment spots. The formation of dark nodules is also possible. These symptoms can serve as the first stage of the development of the disease, and with the onset of the second, the pigmented manifestations are replaced by red, more characteristic of this type of lichen.

The pointed form of red lichen planus is distinguished by the grouping of rashes on the skin of the lower extremities, as well as on the shoulder blades and neck. A rash with this form of lichen in the middle has a hyperkeratosis area, which feels like a pointed horny spike.
The ring—shaped form of lichen planus is a permanent peripheral growth of skin lesions containing foci of regression within the elements. Thus, the ring-shaped shape fully justifies its name, because groups of rashes form circles on the patient’s body. Most often, this form of lichen occurs in men and affects the skin of the inner part of the legs and groin.
The erosive-ulcerative form of lichen planus is marked by its manifestations on the mucous membrane of the oral cavity, when erosions and ulcers are formed there, surrounded by edema, redness and rashes. Such erosions are difficult to treat, they heal for several years. However, even after healing, a relapse may occur when a new erosion occurs in place of the previous one.
Diagnosis of lichen planus
If there are suspicions of lichen planus, the dermatologist usually needs to study only the clinical manifestations of this disease in the patient. But since they can be diverse, in some cases additional tests are prescribed to accurately diagnose lichen planus, for example, on the mucous membrane of the oral cavity.

Specific changes during laboratory tests are not observed in patients.

A blood test is prescribed if it is necessary to investigate the presence of leukocytosis, eosinophilia in the sample.

In some cases, specialists prescribe a diagnostic biopsy, a sample of which is transmitted for histological examination. It will help to identify inflammation, hypergranulosis, hydropic dystrophy of the basal layer of the skin, colloidal Sevatt corpuscles.

Based on the results of the tests, the specialist formulates a diagnosis, indicating the shape of lichen planus. According to this, treatment is prescribed.

Treatment of lichen planus
Since the disease has not yet been fully studied by specialists, and the causes, mechanisms of occurrence and development of the disease are also not known, a variety of treatment methods are used to relieve lichen planus. For example, the use of sedatives and medications helps to relieve itching and tingling sensation on the skin.

Selective phototherapy is actively used to treat lichen planus. Additionally, PUVA therapy is prescribed.

Corticosteroids are used from medicines, for example, prednisone, antimalarial drugs.

Local therapy is generally not prescribed because it is ineffective. However, in the case of the hypertrophied form of lichen planus, medications and hardware techniques are used to destroy the rash growth.

When a rash appears on the mucous membrane of the oral cavity, oils, ointments and preparations such as rotokan or solcoseryl are used to facilitate the course of the disease.

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