Lichen planus is one of the most common skin diseases. It differs from many other dermatoses in its frequent combination with various diseases of internal organs (chronic gastritis, gastric and duodenal ulcers, cirrhosis of the liver, diabetes, etc.).
The basis of the red flat lichen are immune disorders. Under the influence of provoking factors (psychoemotional stress, trauma in the broad sense of the word – mechanical , chemical, drug; hormonal and metabolic disorders), the sensitivity and susceptibility of skin cells to the disease-causing effect is increased.
It is known that immune disorders are controlled by genetic mechanisms. Currently, accumulated data on hereditary susceptibility to red flat deprive. Cases of familial disease with this dermatosis are described, relatives in the second and third generations are more often ill.
Of the many causes of lichen planus, there are three main groups:
- chemical, medicinal substances of domestic and professional nature;
- own biologically active substances arising from stressful situations, diseases of internal organs.
The typical shape of lichen planus is polygonal plaques of a characteristic pink color with a lilac shade;
Hypertrophic form – large nodules and plaques with a warty surface;
Atrophic form – with or without hyperpigmentation;
The bullous form of lichen planus is presented in the form of subcutaneous blisters;
Erythematous form – a common form with redness of the skin.
The flow of lichen planus can be acute (lasts up to 1 month) or subacute (lasts up to 6 months) and takes a long time (more than 6 months).
The defeat of the mucous membranes (usually the oral cavity) occurs in most patients with skin rashes or exists in isolation; plaque, redness, blisters, or sores can be the outward manifestations.
Nail changes are observed in 12–20% of patients, they occur in all forms of lichen planus, but the most severe lesions occur in common forms (bullous and erosive-ulcerative). In this case, the nail plates are deformed in the form of longitudinal ridges, grooves, grooves, the surface of the nail becomes lumpy, a middle crack appears, the plate becomes thinner, until it disappears completely.
Often, skin rashes are accompanied by intense itching.
The diagnosis of lichen planus is performed by a dermatologist and does not present much difficulty, since it is almost always possible to detect typical polygonal-shaped plaques with a characteristic color, smooth surface, umbilical depression, transverse striation.
Multiple rashes are prone to grouping and are localized in “favorite” places: mainly on the flexor surfaces of the forearms, in the elbows, axillary hollows, lower abdomen, lower back, inner thighs, genitals and lower legs.
To clarify the diagnosis produce a biopsy of the skin.
When treating lichen planus is important to consider the conditions conducive to the appearance of the disease. At the same time, it is necessary to eliminate the risk factors – domestic and occupational hazards, associated diseases, and foci of infection.
Spend sanitation of the oral cavity, prosthetics. Food should not cause irritation of the mucous membranes of the mouth. Attention is drawn to prior treatment and tolerability of drugs.
As the main treatment for lichen, hormones are prescribed in combination with 4-aminoquinoline derivatives ( hydroxychloroquine , chloroquine ).
In the presence of pronounced itching, sedatives and antidepressants are shown to help normalize sleep and reduce itching, as well as anti-allergic drugs (tavegil, claritin, telfast , etc.).
Vitamin therapy has a beneficial effect on metabolic processes. Vitamin A affects the division of skin cells (daily dose for adults – 100,000 IU). Vitamin A derivatives ( tigazon , neotigazon , etreionat ) reduce the severity of inflammation and normalize cell division processes. Vitamin A derivatives are more effective if the mucous membrane of the mouth and the red border of the lips are affected. The daily dose is from 25 to 50 mg, the treatment lasts 2–3 weeks. For red lichen, vitamin A analogs – carotenoids (for example, phenoro ) are also used.
Vitamin E ( alpha α-tocopherol acetate) allows for a combined treatment with hormones to reduce the daily dose and reduce the time hormone therapy.
In chronic relapsing course, agents that improve the oxygen supply of tissues (for example, Cyto-Mac, Actovegin ) are shown.
External treatment of lichen planus with hormonal ointments, solutions and mixtures with menthol, anestezin, citric acid, antihistamines is used for intense itching.
Large plaques are destroyed by cryodestruction (freezing) or electrocoagulation (cauterization). Ulcerative foci are treated with healing agents (solcoseryl, sea buckthorn oil, rosehip oil).
Of the methods of non-drug therapy, phototherapy deserves attention (ultraviolet radiation). There are messages on treatment of patients with the laser.
Used therapy with the use of agents that affect the immune system ( reaferon , interlock , neovir , ridostin ). Neovir 12.5% is administered intramuscularly in a dose of 2 ml 1 time per 2-3 days, for a course of 5 injections, ridostin – 2 ml in 2 days on the 3rd, only 4 injections.
Rational choice of drugs, sequential stage (course) use, taking into account the individual characteristics of the patient and the nature of the disease, allows to achieve positive results.