Lichen planus (LP) is a chronic inflammatory disease of the skin and mucous membranes, which is characterized by a rash, itching and the formation of manipulations on the skin surface. LPL, as a rule, manifests itself in the form of flat itchy plaques of purple or red color, covered with a shiny surface. The disease is most often localized on the wrists, ankles, lateral surfaces of the neck and on the mucous membranes of the oral cavity. LPL can develop as an independent pathology, and be associated with other diseases, such as hepatitis, lupus erythematosus and diseases of the gastrointestinal tract. The main mechanisms of pathogenesis include the activation of T-helpers, which leads to an inflammatory reaction that disrupts the normal functioning of skin cells.
History of the disease and interesting historical facts
Red flat lichen was described back in the 17th century, when doctors began to systematize dermatological diseases. However, the first accurate descriptions of RPL appeared in 1869 thanks to the German dermatologist Odon Leber. In the 20th century, active work began on studying the pathogenesis and clinical manifestations of the disease, which made it possible to identify various forms of lichen, as well as develop methods for its diagnosis and treatment. Interestingly, in different historical eras, RPL was perceived as a disease with a mystical meaning, which led to various myths and misconceptions associated with this disease.
Epidemiology
According to various studies, the prevalence of lichen planus is approximately 0.5-1% among the population. The disease is most often observed in adults aged 30 to 60 years, with women suffering from this disease more often than men. Epidemiological data confirm that in recent decades there has been an increase in the number of cases of lichen planus, which may be associated with changes in the environmental situation, high stress levels, and changes in people's lifestyles.
Genetic predisposition to this disease
Studies show that some genetic factors may predispose patients to the development of lichen planus. For example, associations with certain alleles of the major histocompatibility complex (MHC) class II have been identified, which may indicate immune mechanisms that play a role in the pathogenesis of this disease. In particular, mutations in genes responsible for regulating the immune response may also contribute to the development of lichen planus. However, at the moment, this area remains actively researched and requires additional research to draw final conclusions.
Risk factors for the development of this disease
There are a number of factors that can contribute to the development of lichen planus. These include:
- Stressful situations and emotional trauma.
- Infectious diseases such as viral hepatitis.
- Taking medications that help change the immune response (some anti-inflammatory and antimicrobial agents).
- Exposure to chemicals, including medications.
- Chronic diseases of the liver and endocrine system.
Thus, questions related to risk factors for lichen planus are related to both the environmental environment and the patient's body condition.
Diagnosis of this disease
Diagnosis of lichen planus includes several stages. The main symptoms are:
- The appearance of itchy or non-itchy flat papules.
- The shape of the plaques - they usually have a regular shape with a shiny surface.
- Sometimes changes in the nail plate are observed, including longitudinal grooves and detachment.
- The rash can appear simultaneously on the skin and mucous membranes.
The following laboratory tests may be performed to confirm the diagnosis:
- Complete blood count.
- Tests for viral infections - hepatitis B and C.
- Pathohistological examination using skin biopsy.
In some cases, additional diagnostics may be required, including immunological studies and dermatoscopy. Differential diagnosis should be made with other dermatoses, such as psoriasis and fungal infections.
Treatment
Treatment of lichen planus usually involves a comprehensive approach. The general principles of treatment are as follows:
- Avoiding triggers such as stress and suspected allergens.
- Local anti-inflammatory drugs to reduce the appearance of the rash.
- Systemic therapy for severe forms - glucocorticosteroids, immunosuppressants.
Pharmacological treatment may include:
- Corticosteroids (dexamethasone, prednisolone).
- Cyclosporine A and methotrexate for severe cases.
- Antihistamines to reduce itching.
In rare situations, surgery may be required to remove the rash or to apply skin grafts if RPL causes significant skin defects. Other possible treatments include phototherapy and the use of immunomodulators.
List of medications used to treat this disease
Some of the most common medications used to treat lichen planus include:
- Glucocorticosteroids: prednisolone, triamcinolone.
- Immunosuppressants: methotrexate, azathioprine.
- Antihistamines: cetirizine, loratadine.
- Immunomodulators: tacrolimus, pimecrolimus.
- Photosensitizers and phototherapy.
Disease monitoring
Monitoring the course of lichen planus involves regular dermatologist examinations and monitoring for possible complications. It is necessary to monitor changes in the skin condition, as well as for the presence of associated diseases. The prognosis for lichen planus is favorable in most cases, but recurrence of the disease is possible. Complications may include the development of secondary infections, significant cosmetic defects, and even psychological problems associated with changes in appearance.
Age-related features of the disease
Lichen planus can manifest itself differently depending on the age of the patient. In children, it is most often multiplex in nature and can resolve quickly. In adolescents and young adults, the disease usually proceeds more aggressively with pronounced itching, while in older people a milder form may be observed. The latter often develop atrophic forms, which can last much longer without significant relapses.
Questions and Answers
- What causes lichen planus?The cause of RPL has not been fully established, but it is assumed that its development is influenced by immune disorders, stress and some viral infections.
- Is it possible to cure lichen planus completely?There is currently no single cure for RPL, but many patients can achieve long-term remission with combination treatment.
- How long does it take to treat the disease?The duration of treatment depends on the severity of the disease and the individual characteristics of each patient, on average - from several months to several years.
- Can lichen planus come back?Yes, relapses are common with this condition and can be caused by stress or other triggers.
- How to care for skin with lichen planus?It is recommended to use hypoallergenic skin care products, avoid harsh chemicals and protect damaged areas from external irritants.
Advice from Dr. Oleg Korzhikov
Dr. Oleg Korzhikov recommends the following to manage the symptoms of lichen planus:
- Consult a dermatologist regularly to monitor the condition.
- Pay attention to stress factors and try to minimize their impact on your life.
- Use moisturizing creams and lotions to hydrate damaged skin.
- Monitor your diet to include antioxidants and vitamins to support your immune system.
- Don't forget about adequate sleep and physical activity - this will help improve your overall health."
Thus, a proper understanding of the nature of lichen planus and its treatment can significantly improve the quality of life of patients suffering from this disease.
