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Lichen planus

The Lichen planus is a relatively dermatitis often characterized by papules (elevations, bumps) small, purplish and polygonal can be grouped into plaques (when multiple papules come together giving a greater area), usually accompanied by intense pruritus (itching).

The evolution is chronic and recurrent (it repeats from time to time). It occurs at any age, although it is more frequent between 30-60 years, and is distributed throughout the world, without racial or sexual predominance.

Causes of lichen planus

It is totally unknown, although there are a number of associated factors:

  • Genetic factors: a family association has been seen.
  • Psychological factors: psychological trauma, strong emotions, death of family members. They have been related to the beginning and the chronification.
  • Physical trauma: could act as a trigger.
  • Infectious factors: according to this theory, a virus in a latent state could be activated and cause disease by the action of drugs or mental disorders, but it has not been clearly demonstrated.
  • Immunological factors: an association has been seen with some autoimmune diseases such as lupus erythematosus, primary biliary cirrhosis , myasthemia gravis, etc.
  • Toxic factors: smokers have seen a higher incidence of plaque lesions. Chewing tobacco has been linked to oral lichen planus.
  • The sun induces a form of lichen planus in which lesions may appear on the oral mucosa.

The mechanism by which these factors produce this disease is unclear.

Symptoms of lichen planus

The elemental lesion is a flat, polygonal, pinkish elevation in the skin (papule) that glows with changes in light. As time passes it turns gray. In the end it disappears without leaving a scar. It is small, no more than 6-8 mm, but they often join together giving a larger lesion (plaques). They are accompanied by intense itching (pruritus).

It is characteristic the presence of a bright whitish pattern, with the appearance of a net, on the surface of the papules, which are more clearly seen by moistening them with alcohol.

The most frequent locations are the wrists and forearms, lower lumbar area, lateral part of the abdomen, hands and feet. The scalp, nails, and oral and genital mucosa are also frequently affected.

Skin involvement

The number of lesions is highly variable, they may appear few and isolated or in greater numbers, which end up joining together. On the legs, palms and soles they take on a higher and drier appearance.

Nail involvement

It appears in 10% of cases. There is a thickening of the nail with longitudinal grooves; They appear brittle and sometimes atrophy and can disappear.

Scalp involvement

There is a progressive destruction of the hair follicle due to the lesions, leaving an irreversible scarring alopecia .

Mucosal involvement

The oral or genital mucosa is affected in 60% of the cases; associated with the cutaneous manifestation or in isolation.

  • Oral mucosa: it appears mainly in the mucosa of the gums, appearing whitish, shiny streaks that extend from back to front. They are very chronic and have no symptoms. They must be watched for possible malignancy. When the tongue is affected, whitish lesions appear on the back and lateral faces that join together, giving larger ones. Very characteristic small porcelain-like papules appear on the lips, usually the lower one. They can sometimes lead to bleeding lesions that are covered with scabs.
  • Genital mucosa: in the male they adopt a ring shape around the penis. In women they are located on the inside of the labia majora.
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Evolution is unpredictable. There are forms of rapid appearance, generalized with a chronic evolution and with very intense itching (pruritus). Others evolve slowly and progressively, without itching, new lesions appearing while others disappear spontaneously. Between these two extreme types there are multiple variations.

clinical forms

Lichen planus is one of the dermatoses with the most clinical varieties, some of which are very difficult to diagnose.

  • Bullous lichen planus. It presents a very acute clinic, with generalized lesions and intense itching; Tension blisters may appear on the lichen papules. When they break, they leave a bleeding surface with slow and complicated evolution. In the oral mucosa they leave significant ulcerations.
  • Atrophic lichen planus. It is characterized by the fact that in typical lesions, the center atrophies and flattens, adopting a white color.
  • Hypertrophic lichen corneum or warty lichen. It is very chronic and itchy (itchy) with lesions on the legs and ankles, with a warty and rough appearance, leaving the hyperpigmented area (very colored) as a sequel.
  • Pilar or follicular lichen planus. The lesions are located in the hair follicles, which appear rough to the touch. They are located on the arms, back, scalp and face, and leave scarring alopecia as a sequel due to destruction of the follicle. The most extensive form is called Lasuer Graham Aittle syndrome, with definitive alopecia on the scalp, armpits and pubis.
  • Actinic lichen planus. It only sprouts on areas of skin exposed to the sun.

How is it diagnosed?

Diagnosis is made primarily by visual observation of typical lesions.

In some cases, it will be necessary to carry out an anatomopathological study in which the specific changes in the cutaneous cell structure and behavior will be observed, which will give us a certain diagnosis.

Lichen planus treatment

Treatment in general is difficult and often disappointing. Various metals, antibiotics, vaccines, vitamins, etc. have been used with highly variable results.

  • As a first measure, the alleged causal agents will have to be eliminated.
  • For itching: antihistamines and sedatives.
  • If there are only lesions in one skin area, the application of strong corticosteroids in that area may be helpful.
  • Oral corticosteroids in small doses and for a limited time are useful to reduce itching and shorten the outbreak, but, since most have a chronic evolution, special care must be taken due to the side effects of corticosteroids in prolonged treatments .
  • Isonicotinic acid hydrazides: it has been recommended by several authors for its anti-inflammatory action.
  • Methotrexate: in very severe and generalized forms, with great general repercussion.
  • Other treatments: photochemotherapy (PUVA), griseofulvin, cyclosporine.

How can it be avoided?

Being of unknown cause, it is very difficult to prevent its appearance, only trying to suppress the etiological factors, although most are not clear or are not avoidable.

It is important to avoid scratching the lesions as much as possible once they have appeared, since this can lead, by itself, to complications that would lengthen the healing process.

A dermatologist should be consulted in the event of pruritic lesions such as those described above.

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Hello Readers, I am Nikki Bella a Psychology student. I have always been concerned about human behavior and the mental processes that lead us to act and think the way we do. My collaboration as an editor in the psychology area of ​​Well Being Pole has allowed me to investigate further and expand my knowledge in the field of mental health; I have also acquired great knowledge about physical health and well-being, two fundamental bases that are directly related and are part of all mental health.

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