Lichen red plane: Difference between revisions
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(Original text from Wikiscripta: Lichen ruber planus https://www.wikiskripta.eu/index.php?curid=10342) |
(original text from wikiscripta : (https://www.wikiskripta.eu/index.php?title=Lichen_ruber_planus&curid=10342)) |
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[[ | [[Image:Lichen ruber 2.jpg| thumb| right |Lichen ruber – whitish deposits (Wickham's striae) on the knees and ankles]] | ||
''Lichen ruber | ''Lichen ruber – whitish deposits (Wickham's striae) on the knees and ankles '''the characteristic features''' of which are: | ||
* itchy flat red-brown papules about 1 mm in diameter, waxy, | * itchy flat red-brown [[Kožní eflorescence#Primární eflorescence|papules]] about 1 mm in diameter, waxy, | ||
* typical histopathological findings, | * typical histopathological findings, | ||
* affecting mucous membranes, hair and nails | * affecting mucous membranes, hair and nails. | ||
=== Etiology === | === Etiology === | ||
The etiology of the disease is unclear. The | The etiology of the disease is unclear. The involvement of cytotoxic [[T-lymphocytes|T-lymphocytes]] directed against [[antigens]]in the area of the basement membrane is considered . The disease is related to chronic liver diseases ([[hepatitis C]] and [[hepatitis D]]) and the administration of drugs ([[beta-blockers]]). | ||
=== | === clinical picture === | ||
Symmetrical seeding of itchy, flat, shiny, polygonal, red-brown papules is typical for lichen planus. On the surface of the papules, | Symmetrical seeding of itchy, flat, shiny, polygonal, red-brown papules is typical for lichen planus. On the surface of the papules, Wickham's striae can sometimes be visible - a whitish pattern that is due to hypergranulosis. Hyperpigmentation persists after papules heal. | ||
'''Predilection locations''' are: | '''Predilection locations''' are: | ||
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* cross landscape, | * cross landscape, | ||
* instep, ankle. | * instep, ankle. | ||
[[ | [[File:Lichen-ruber-planus.png|350 px|thum|right|Predilection localization]] | ||
=== Clinical | === Clinical forms === | ||
;Exanthematic form | ;Exanthematic form | ||
:It is a massive acute seeding of small papules, mainly on the trunk, which can turn into [[ | :It is a massive acute seeding of small papules, mainly on the trunk, which can turn into [[erytroderma]]. Asymptomatic whitish reticular venation on the buccal mucosa may be present (in up to half of patients). In 10% of patients, there are also changes in the nails. | ||
; | ;Lichen planus annularis | ||
:Manifestations can sometimes be grouped into rings. This form often affects the genitals. | :Manifestations can sometimes be grouped into rings. This form often affects the genitals.. | ||
;Lichen planus | ;Lichen planus mucosae | ||
:It manifests as painful erosions and scarring, especially around the oral cavity and anus. | :It manifests as painful erosions and scarring, especially around the oral cavity and anus. | ||
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:The formation of follicular-bound and often confluent pointed hyperkeratotic red papules is characteristic. It can lead to scarring [[alopecia|alopecia]]. | :The formation of follicular-bound and often confluent pointed hyperkeratotic red papules is characteristic. It can lead to scarring [[alopecia|alopecia]]. | ||
;Lichen | ;Lichen unguium | ||
[[ | [[Image:Lehman, 2009 Fig11.tiff|náhled|Lichen unguium]] | ||
:There is thinning of the discs, deformation of the discs. Subungual hyperkeratoses can lead to total nail loss. | :There is thinning of the discs, deformation of the discs. Subungual hyperkeratoses can lead to total nail loss. | ||
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=== Histopathological finding === | === Histopathological finding === | ||
* [[Acanthosis]], hypergranulosis, orthohyperkeratosis epidermis, | * [[Acanthosis]], hypergranulosis, orthohyperkeratosis epidermis, | ||
* mononuclear striated infiltrate in the upper [[ | * mononuclear striated infiltrate in the upper [[Anatomical composition of the skin, skin attached#Corium (škára, dermis, cutis)|corium]] penetrating into the lower parts[[Anatomical composition of the skin, skin attached#Epidermis (skin)|epidermis]], the dermo-epidermoid junction is not sharp, forming "saw teeth", | ||
* [[ | * [[vacuolar degeneration of keratinocytes]] in the basal layer, clusters of cytoid bodies - Civatte bodies, | ||
* loss of melanin in the corium – here the melanin pigment is absorbed by [[macrophages]], | * loss of melanin in the corium – here the melanin pigment is absorbed by [[macrophages]], | ||
* direct [[ | * direct [[immunofluorescence |imunofluorescence]] demonstrates [[IgM]] and [[IgG]] immunopositivity. | ||
=== Differential diagnosis | === Differential diagnosis === | ||
* [[Psoriasis]], | * [[Psoriasis]], | ||
* [[pityriasis rubra pilaris]], | * [[pityriasis rubra pilaris]], | ||
* [[drug eruptions]], | * [[drug eruptions]], | ||
* [[ | * [[bullous dermatoses]]. | ||
=== Therapy === | === Therapy === | ||
* Local – [[ | * Local – [[Corticosteroids]], application of [[immunomodulators |immunomodulators]] (tacrolimus, pimecrolimus), disinfecting rinses for mucosal lesions, local anesthetics . [[anesthetics]]. | ||
* General treatment for extensive forms – corticosteroids or retinoids. | * General treatment for extensive forms – corticosteroids or retinoids. | ||
== | == Link == | ||
=== Related | === Related articles === | ||
* [[ | * [[Lichenifikace]] | ||
=== References=== | === References === | ||
* {{ | * {{Cite | ||
| | | type = book | ||
| | | surname1 = Štork | ||
| | | name1 = Jiří | ||
| | | group = again | ||
| | | title = Dermatovenerologie | ||
| | | edition = 1 | ||
| | | location = Prague | ||
| | | publisher = Galén | ||
| | | year = 2008 | ||
| | | range = 502 | ||
| isbn = 978-80-7262-371-6 | | isbn = 978-80-7262-371-6 | ||
}} | }} | ||
[[ | [[Category:Dermatovenerology]] | ||
[[ | [[Category:Pathology]] | ||
Revision as of 03:07, 11 June 2023
Lichen ruber – whitish deposits (Wickham's striae) on the knees and ankles the characteristic features of which are:
- itchy flat red-brown papules about 1 mm in diameter, waxy,
- typical histopathological findings,
- affecting mucous membranes, hair and nails.
Etiology
The etiology of the disease is unclear. The involvement of cytotoxic T-lymphocytes directed against antigensin the area of the basement membrane is considered . The disease is related to chronic liver diseases (hepatitis C and hepatitis D) and the administration of drugs (beta-blockers).
clinical picture
Symmetrical seeding of itchy, flat, shiny, polygonal, red-brown papules is typical for lichen planus. On the surface of the papules, Wickham's striae can sometimes be visible - a whitish pattern that is due to hypergranulosis. Hyperpigmentation persists after papules heal.
Predilection locations are:
- volar sides of the wrist,
- cross landscape,
- instep, ankle.
Clinical forms
- Exanthematic form
- It is a massive acute seeding of small papules, mainly on the trunk, which can turn into erytroderma. Asymptomatic whitish reticular venation on the buccal mucosa may be present (in up to half of patients). In 10% of patients, there are also changes in the nails.
- Lichen planus annularis
- Manifestations can sometimes be grouped into rings. This form often affects the genitals..
- Lichen planus mucosae
- It manifests as painful erosions and scarring, especially around the oral cavity and anus.
- Lichen planopilaris
- The formation of follicular-bound and often confluent pointed hyperkeratotic red papules is characteristic. It can lead to scarring alopecia.
- Lichen unguium
- There is thinning of the discs, deformation of the discs. Subungual hyperkeratoses can lead to total nail loss.
- Lichen palmoplantaris
- These are diffuse yellow-brown-red hyperkeratoses of the palms and soles, sometimes with ulcerations
- Lichen planus verrucosus
- Verrucous raised red-brown lesions appear, often on the shins.
Histopathological finding
- Acanthosis, hypergranulosis, orthohyperkeratosis epidermis,
- mononuclear striated infiltrate in the upper corium penetrating into the lower partsepidermis, the dermo-epidermoid junction is not sharp, forming "saw teeth",
- vacuolar degeneration of keratinocytes in the basal layer, clusters of cytoid bodies - Civatte bodies,
- loss of melanin in the corium – here the melanin pigment is absorbed by macrophages,
- direct imunofluorescence demonstrates IgM and IgG immunopositivity.
Differential diagnosis
Therapy
- Local – Corticosteroids, application of immunomodulators (tacrolimus, pimecrolimus), disinfecting rinses for mucosal lesions, local anesthetics . anesthetics.
- General treatment for extensive forms – corticosteroids or retinoids.
Link
Related articles
References
- ŠTORK, Jiří. Dermatovenerologie. 1. edition. Prague : Galén, 2008. 502 pp. ISBN 978-80-7262-371-6.
