Related articles: Lichen planus
Definition
Lichen planus is a disease that affects the skin and mucous membranes, causing a recurrent and itchy inflammatory eruption. At the base of the pathology there is an autoimmune reaction mediated by anomalous cytotoxic T lymphocytes, which attack epithelial keratinocytes.
Lichen planus can be triggered by various chemical, biological or pharmacological agents (especially β-blocker drugs, NSAIDs, ACE inhibitors, sulfonylureas, antimalarials, penicillamine and thiazides). Recently, associations have been reported with hepatic C-related hepatic failure, primary biliary cirrhosis and other forms of hepatitis. Moreover, all these possible triggering causes would cause liche planus only in the presence of a genetic predisposition to the disease.
Lichen planus, rare in children, can affect the skin and oro-genital mucosa. Onset of the disease can be sudden or gradual.
Most common symptoms and signs *
- Oral aphthosis
- Alopecia
- bubbles
- Burning to the tongue
- Skin discoloration
- Glossitis
- White Tongue in Children
- Inflated tongue
- Yellow tongue
- onycholysis
- papules
- Nail pitting
- plaques
- itch
- Scales on the skin
- Nails with vertical lines
- Brittle nails
- Coarse and opaque nails
- blisters
Further indications
Typical lesions of lichen planus are single papules, of small dimensions (2-4 mm in diameter), with polygonal edges, with a flat and purple surface. These papules can flow together to form scaly, itchy and rough plaques. Usually, the rash is distributed symmetrically, especially at the level of the trunk and flexor surfaces of both limbs. The face, however, is rarely involved.
Over time, lesions may become hyperpigmented, hyperkeratotic or vesico-blistered, but rarely become crusty. When the scalp is involved, patchy alopecia can occur.
Cutaneous manifestations are often accompanied by injuries to the oral cavity. Even the vulvar and vaginal mucous membranes are often affected by reddish lesions, with itching and burning; similarly, genital involvement, particularly of the glans, is frequent in men. The nails may present alterations ranging from discoloration of the nail bed, to longitudinal streaks and fissures; thinning of the foil can lead to complete loss of the nail.
Diagnosis is suggested by the characteristics of the lesions and may be supported by skin biopsy. Similar lesions can be found in lupus erythematosus, syphilis, candidiasis, canker sores and pemphigus.
Treatment options differ depending on the location and extent of the disease. Most cases of lichen planus can be treated with topical medications (eg corticosteroids). In severe cases, however, it may be necessary to resort to systemic immunosuppressants.
