Lichen puber planus
Lichen ruber planus represents a frequent morbid condition of the skin and mucous membranes, which consists of itchy papules, atrophic or erosive bubbles. Despite the hypothesis that the pathogenesis of lichen ruber planus is immunological, the aetiology is still doubtful and unknown: however, it seems to be established that viruses do not affect the manifestation of dermatosis in any way.
Incidence
Causes and affected areas
The triggers that are at the base of lichen ruber planus are completely unknown: it has been found that the patients of this dermatosis present strong anxiety states, but the reason that regulates it all remains a shady area. Some authors venture a particular theory: based on the studies carried out, it seems that stress greatly affects the clinical evolution of the disease. The chronic course of lichen ruber planus, albeit benign, could therefore be fomented (not caused) by neurotransmitters of stress [taken from www.latuapelle.org].
Although it can ideally spread in all body areas, lichen ruber planus mainly affects the wrists, the lumbo-sacral area, the hips and the genitals; in addition, nails, oral and genital mucosa, and scalp are also possible targets of dermatosis.
injuries
It is difficult to construct a clear clinical picture, since the lichen ruber planus does not manifest itself with the same skin lesions in every patient: the papules typical of the disease may present different shape, size, location and disposition, sometimes making the recognition of the disease intricate.
The statistical data reveal that in 10% of cases the whitish papules of lichen ruben planus tend to heal in the central area, but to expand towards the periphery, with a particular circular pattern (typical manifestation of the lichen at the level of the glans responsible, sometimes balanopostitis or balanitis). Rarely, lesions follow a linear distribution.
- Location of injuries
Papules in the skin take on a polygonal, reddish or whitish color, with a diameter that can vary from 3 to 10 mm. On the inner mucous membranes of the cheeks (mucous genes) and on the tongue, on the other hand, the lichen ruber planus could favor the formation of branched and reticulated whitish papules. Furthermore, the lichen ruber planus at palmo-plantar level could generate rigid and hyperkeratotic reliefs, very similar to corns.
The papules generated by the lichen ruber planus can be located near the hair follicles, generating the fall of the hair, with subsequent permanent damage to the follicle itself.
- Papule structure
In general, the papules of the lichen ruber planus appear very small, comparable to the size of the head of a pin; but there are certainly exceptions, as these could increase in volume, spreading to the surrounding areas. When the papules no longer appear to be flat (hence the term "planus" of the disease), one speaks more correctly of lichen ruber acumunatus (a disease first described in the mid-nineteenth century by MK Kaposi, the famous Hungarian dermatologist of the time ) today known as pitriasi rubra pilaris .
At the level of the limbs, the papules can assume a pierced appearance, associated with the formation of particularly itchy warts.
On the papules of lichen ruber planus, a whitish lattice generally appears: it is a typical sign of dermatosis, which allows immediate recognition. The papules can remain isolated or group together forming real abnormal clusters. The main problem, which hinders the diagnosis, is given by the substantial scratching generated by the papules: the affected subject, through the rubbing, removes the superficial film of the lesion, preventing the clinical recognition.
In some subjects, the actinic lichen ruber planus forms papules and bubbles, favored even more by sun exposure; in this form of lichen, the itching is almost zero.
Classification
The lichen ruber planus is classified according to the morphological characteristics of the papules and of the location:
- Lichen ruber planus of verrucous or hypertrophic type: typical lichen of the leg, in which the papules, dry and scaly, tend to be slightly in relief from the skin. Often papillomatosis (a pathology that is distinguished by the presence of papillomas in the skin / mucous membrane) and evident hyperkeratosis are found.
- Bullet-type Lichen ruber planus: as the morbid condition predicts, blisters or blisters of various sizes can form on the skin. The lesions are responsible for a progressive skin degeneration that damages the epidermal basal layer.
- Lichen ruber planus of the follicular type: the dermatosis affects the follicles, creating considerable damage when the scalp is also affected, since it causes the hair to fall, therefore permanent non-reversible alopecia.
[extract from Treatise on clinical pathological anatomy of M. Raso]
Course of the disease
The disease may have a chronic or acute course, but fortunately it tends to regress spontaneously, without particular need for pharmacological therapies (except for patients who complain of obsessive and relentless itching). When the plaques and papules formed change color and become dark, it is a clear sign of self-healing of the lichen ruber planus.
Care
No case of asymptomatic lichen ruber planus has been reported: all patients complain of itching, although the intensity of it may vary considerably from subject to subject. In some cases, itching is so insignificant that drugs are not indispensable (actinic lichen ruber planus).
The patient, with a medical prescription, can use corticosteroid-based creams or ointments (topical application) or oral administration of vitamin PP; the patient can also use antihistamines to calm the itching.
When lichen ruber planus is accompanied by an evident anxiety state of the patient, administration of spasmolytic pharmacological specialties is recommended.
Summary
Lichen ruber planus: in short
| Disease | Lichen ruber planus |
| Description | Frequent morbid condition of the skin and mucous membranes, which consists of pruritic papules, atrophic or erosive bubbles |
| Incidence of lichen ruber planus |
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| Areas affected by the disease | It mainly affects the wrists, the lumbo-sacral area, the hips and the genitals. Less common is the lichen ruber planus at the level of nails, oral and genital mucosa, scalp |
| Aetiology | Completely unknown |
| assumptions | Stress and anxiety could cause the disease to progress |
| Clinical manifestations |
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| Classification |
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| Course of the disease | Chronic or acute course, but fortunately tends to regress spontaneously |
| Therapeutic treatment against lichen ruber planus |
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