Lichen planus or psoriasis is a condition characterized by a chronic rash.
- Mucous membrane
Lichen planus can occur in different areas of the body and can be accompanied by itching in the genital area (genital or anal), on the skin or in the mouth.
The rash is due to:
Papules marked. These lesions can confluence with each other to form rough and scaly plaques on the skin.
There may also be rashes on:
- Oral mucosa
Lichen planus is not contagious:
- you can’t get it from other people
- or transferred to them.
However, it can negatively affect the quality of life.
Causes of lichen planus
The exact cause of lichen planus is unknown.
Lichen planus is thought to be an autoimmune disease.
The T cells (lymphocytes) attack the skin cells because they see them as a danger to the body.
Some risk factors for this disease may include:
- Exposure to pharmaceuticals, dyes and chemical substances such as:
- Viral diseases such as hepatitis C or herpes zoster
- Skin trauma
Lichen planus mainly affects adults between 30 and 60 years of age, less frequently children.
How does lichen planus manifest itself?
Lichen planus can take different forms.
Classical lichen planus
It is marked by:
- coarse papules.
The lesions can take on different sizes, from a dot to the size of one centimeter.
They are often purple and are crossed by thin white lines (Wickham stripes).
They can spread and group themselves to:
- lines (linear lichen planus),
- Wrestling (annular shaped).
Or they follow a nerve course (zosteriform).
Linear lichen planus can be a result of scratches or injuries on the skin. Even if no other symptoms are noticeable, this disorder can be very itchy.
Lichen planus can affect any zone of the body, but usually it is observed:
- at the front of the wrist,
- on the lower back,
- on the ankles,
- on the side of the neck,
- in the genital area.
On the palms and soles of the feet, the papules are firm and yellow-brownish.
New lesions may form while the others pass. Once the pales of lichen planus have healed, they are replaced by a gray-brown discoloration, especially in people with dark skin. This is called post-inflammatory hyperpigmentation and it can persist for months.
Variants of the classical lichen planus
Lichen planus verrucosus or hypertrophicus patients with the verrucosus
type have thick plaques with hyperkeratosis on the shins.
Very thick and scaly areas are particularly itchy and occur mainly in the ankle area (hypertrophic lichen planus).
Papillomas (wart-like structures) can form on the skin.
Actinic lichen planus
It develops mainly in areas exposed to the sun, such as:
- Back of the hand.
Bullous lichen planus
Occurs rarely. The blisters or blisters occur in the area of the papules of the lichen planus or isolated, usually on the lower legs.
Erosiver lichen planus
The erosive lichen planus is a rare form and is characterized by superficial and painful erosions.
The erosions can last for a long time. Affected entities include:
- Genitals (especially the females).
Lichen planus pigmentosus
In some patients, gray-brown, oval and poorly defined spots appear:
- face and neck,
- Torso and limbs.
This lichen form shows up without previous phases of inflammation.
In some cases, lichen planus pigmentosus develops on sun-exposed areas of the skin.
In other cases, it occurs in sun-protected places, such as the armpits. It shows a diffuse or reticulated pattern.
Lichen planus pigmentosus can occur in the same or similar form as erythema dyschromicum perstans.
A skin biopsy confirms the lichenoid properties of lichen planus pigmentosus.
Lichenoid drug rash Refers to a rash
similar to lichen planus caused by drugs. It can:
- pink asymptomatic or itchy,
- slightly scaly and flat
Unlike lichen planus, lesions do not have a polygonal shape. In addition, the Wickham stripe is missing.
Sometimes the oral mucosa (oral lichenoid reaction) and other parts of the body can also be affected.
Many medicines occasionally cause lichenoid rashes.
The most common are:
- gold salts used in arthritis;
- antimalarials such as hydroxychloroquine;
- Thiazide diuretics, are used for hypertension and heart failure.
Lichenoid drug rashes recede only slowly after the causative drug has been stopped.
Classification by affected area
Oral lichen planus
The mouth is involved in 50% of cases and often this is the only affected area. The most affected zones in the oral cavity are:
- inside of the cheeks,
- Edges of the tongue.
The gums and lips can also be affected.
The most common features are:
- Painless, white, reticulated or fern-like stripes;
- painful and persistent ulcers (lichen planus erosivus);
- diffuse redness and skinning of the gums (gingivitis desquamativa).
In some cases, the lichen planus that hits the gums is caused by mercury contained in the amalgam fillings of the teeth.
In these patients, the lichen planus can disappear thanks to the replacement of the material of the dental fillings.
Oral lichen planus and intestinal diseases
There are studies that show a link to celiac disease.
Researchers believe there is also a link to the chronic inflammatory diseases of the dram, such as:
Atrophic oral lichen planus
Lichen planus defines itself atrophically when it affects the back of the tongue.
Atrophic oral lichen planus causes:
- degeneration (atrophy) of the papillae,
- painful ulcers (worsening from spicy or acidic food).
Plaque-like oral lichen planus
The plaque-like form of lichen is a subspecies that appears on the oral mucosa and resembles leukoplakia (whitish lesions).
Lichen planus of the vulva
As in the oral cavity, lichen planus can cause white, painless, streaky changes.
The external female genitalia are particularly affected by the erosive form of:
- lichen planus,
- Lichen sclerosus et atrophicus.
Erosive lichen planus
The erosive lichen planus concerns:
- labia minora (labia minora),
- Introitus (vaginal entrance),
The affected mucosa is:
- shiny red,
This disease can provoke severe anatomical and functional changes in the female external genitalia:
- The labia minora can narrow and shrink and connect to the labia majora (outer labia).
- Erosive lichen planus can be very painful, especially during sexual intercourse.
- It can scar and narrow the vagina.
Lichen planus of the glans penis
The classic papules are the most common appearance of lichen planus on the penis, which manifests itself mainly in a ring-shaped infestation around the glans penis (foreskin).
White stripes and erosive lichen planus are less common on the penis.
Lichen planus follicularis, also known as lichen planopilaris, causes small red papules covered by hard skin (hyperkeratosis).
The papules form around a head of hair, for example on the scalp.
Along with the lesions occur:
- hair loss around the papules,
- thinning of hair,
- hairless scars.
The formation of blisters within the skin lesions is rare.
Permanent bald spots can develop.
Areas with scars may slowly appear (alopecia).
This disease is called pseudo pad. If the cause is unknown, it is called Pseudopelade Brocq.
Frontal fibrosing alopecia is believed to be a limited form of lichen planopilaris.
Lichen planus of the nails
In 10% of cases, one or more nails are affected, sometimes without involving the skin surface. If only the nails are affected and if they are all abnormal, it is called a twenty-nail dystrophy. This dystrophy is more common in children.
Characteristics of the lichen planus of the nails:
- The nail plate appears thin and may be grooved and split.
- The nail may turn dark, thicken or lift off in the area of the nail bed (oncholysis).
- Sometimes the cuticle breaks and a scar (dorsal pterygium) forms.
- In some cases, the nails splinter and stop growing, rarely they are completely lost.
Investigations and analyses in lichen planus
The dermatologist can justify the diagnosis according to the appearance on the skin or oral mucosa.
Biopsy of a lesion on the skin or in the mouth can confirm the diagnosis. Blood tests can rule out hepatitis.
Therapy for lichen planus and medication
On the skin, lichen planus can last from a few months to a few years and then spontaneously disappear again.
If the mucous membrane is affected, then the disease may be more persistent towards therapy and recurrence.
Pharmaceuticals and other treatments can reduce itching and promote healing.
Corticosteroids can reduce inflammation caused by lichen planus. The side effects of cortisone vary according to the way it is used:
- application of ointment on the skin,
Corticosteroids are considered a safe method if taken as prescribed and their use is short-term. Common side effects of topical corticosteroids can include skin problems such as:
When taking tablets or being treated with injections, side effects may include:
Retinoids are synthetically produced substances whose chemical structure is related to vitamin A and:
- applied locally,
- be administered orally.
Retinoids are an effective therapy, but they can also cause unpleasant skin irritation, such as:
Oral retinoids are not indicated for pregnant women or women who wish to have children, as they can harm the fetus. The doctor may recommend pregnant or lactating women to choose local retinoid therapy at a later date or to switch to alternative treatment.
Topical calcineurin inhibitors inhibit the activity of the immune system in lichen planus. They seem to be particularly effective in the treatment of lichen planus of the mucous membranes.
Examples of these topical drugs include:
- Tacrolimus (Protopic),
- Pimecrolimus (Elidel).
Antihistaminika wirken gegen ein Protein namens Histamin, das an Entzündungsprozessen beteiligt ist.
Ein orales oder lokales Antihistaminikum kann durch Lichen planus verursachten Juckreiz und Schmerz lindern.
Licht- oder Phototherapie kann die Heilung bei Lichen planus, der die Haut befallen hat, fördern.
Die häufigste Phototherapie bei Lichen planus ist die Anwendung von B-ultravioletten Strahlen (UVB), die nur die oberste Hautschicht (Epidermis) durchdringen. Bei dieser Behandlung besteht das Risiko eines Sonnenbrandes.
Die Phototherapie nutzt A-ultraviolette Strahlen (UVA) in Kombination mit dem Medikament Psoralen, das wirksam sein kann, doch auf längere Zeit ein leichtes Risiko birgt für:
Befürchtet der Arzt, dass ein Lichen planus mit einer Hepatitis-C-Infektion, mit einer chemischen Substanz oder einem Medikament, das eingenommen wird, zusammenhängt, empfiehlt er eine Möglichkeit, den Risikofaktor zu umgehen, indem er zum Beispiel nach einem anderen Medikament sucht und die schädlichen Substanzen vermeidet.
Nutrition and diet
It is advisable to avoid foods that can make the condition worse, such as dairy products and gluten.
Natural remedies for lichen planus
herb experts use seeds and the above-ground parts of the plant to treat:
- neurological pain,
- Skin diseases
- nervous exhaustion.
Applied externally, oats relieve the itching caused by lichen planus.
Oats can also reduce stress and prevent the onset of disease.
Tea tree oil The leaves of the tea tree produce an essential oil
that has anti-inflammatory and antimicrobial properties.
Tea tree oil can help relieve the symptoms of lichen planus on the skin and in the mouth.
It is recommended:
- dissolve a few drops of tea tree oil in a cup,
- apply to the lesions with gauze.
Prognosis for patients with lichen planus
Normally, lichen ruber is not harmful and heals more easily under therapy.
Often this disease passes within 18 months, but it can reappear after years.
If lichen planus is caused by a medication that is currently being taken, the skin symptoms should disappear as soon as the medicine is discontinued.
- Lichen sclerosus of the vulva, glans penis and foreskin
- Molluscum contagiosum or molluscum wart
- Red dots on the glans penis.