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: Lichen ruber planus https://www.wikiskripta.eu/index.php?curid=10342) |
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=== Etiology === | === Etiology === | ||
The etiology of the disease is unclear. The participation of cytotoxic [[T-lymfocytes|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, '''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. | ||
[[ | [[file:Lichen-ruber-planus.png|350 px|thum|right|Predilekční lokalizace]] | ||
=== | === Clinical formsy === | ||
; | ;Exanthematic form | ||
: | :It is a massive acute seeding of small papules, mainly on the trunk, which can turn into [[ erythroderma]]. 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. | ||
; | ;Annular lichen planus | ||
: | :Manifestations can sometimes be grouped into rings. This form often affects the genitals. | ||
;Lichen planus | ;Lichen planus mucosa | ||
: | :It manifests as painful erosions and scarring, especially around the oral cavity and anus. | ||
;Lichen planopilaris | ;Lichen planopilaris | ||
: | :The formation of follicular-bound and often confluent pointed hyperkeratotic red papules is characteristic. It can lead to scarring [[alopecia|alopecia]]. | ||
;Lichen | ;Lichen nail | ||
[[ | [[file: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. | ||
;Lichen palmoplantaris | ;Lichen palmoplantaris | ||
: | :These are diffuse yellow-brown-red hyperkeratoses of the palms and soles, sometimes with ulcerations | ||
;Lichen planus verrucosus | ;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 [[Anatomické složení kůže, kožní adnexa#Corium (škára, dermis, cutis)|corium]] penetrating into the lower parts [[Anatomické složení kůže, kožní adnexa#Epidermis (pokožka)|of the epidermis]], the dermo-epidermoid junction is not sharp, forming "saw teeth", | ||
* [[Poruchy metabolismu vody#Vakuolární dystrofie| | * [[Poruchy metabolismu vody#Vakuolární dystrofie|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 [[Imunofluorescenční vyšetření v dermatologii| immunofluorescence ]] demonstrates [[IgM]] and [[IgG]] immunopositivity. | ||
=== | === Differential diagnosis === | ||
* [[ | * [[Psoriasis]], | ||
* [[pityriasis rubra pilaris]], | * [[pityriasis rubra pilaris]], | ||
* [[ | * [[drug eruptions]], | ||
* [[ | * [[drug eruptions]]. | ||
=== | === Therapy === | ||
* | * Local – [[ corticosteroids]], application of [[imunomodulancia|immunomodulators]] (tacrolimus, pimecrolimus), disinfecting rinses for mucosal lesions, local [[anesthetics]]. | ||
* | * General treatment for extensive forms – corticosteroids or retinoids. | ||
== | == Links == | ||
=== | === Related Articles === | ||
* [[ | * [[lichenificace]] | ||
=== | === References=== | ||
* {{Citace | * {{Citace | ||
| typ = kniha | | typ = kniha | ||
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| jméno1 = Jiří | | jméno1 = Jiří | ||
| kolektiv = ano | | kolektiv = ano | ||
| titul = | | titul = Dermatovenerology | ||
| vydání = 1 | | vydání = 1 | ||
| místo = Praha | | místo = Praha | ||
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}} | }} | ||
[[ | [[Categorie:Dermatovenerologie]] | ||
[[ | [[Categorie:Pathology]] | ||
Revision as of 22:00, 28 March 2023
thumb| right |Lichen ruber – bělavá ložiská (Wickhamovy strie) na kolenou a hleznech Lichen ruber planus belongs to the erythemato-papulo-squamous dermatoses, 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 participation of cytotoxic 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, 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 formsy
- Exanthematic form
- It is a massive acute seeding of small papules, mainly on the trunk, which can turn into erythroderma. 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.
- Annular lichen planus
- Manifestations can sometimes be grouped into rings. This form often affects the genitals.
- Lichen planus mucosa
- 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 nail
- 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 parts of the 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,
- direct immunofluorescence demonstrates IgM and IgG immunopositivity.
Differential diagnosis
Therapy
- Local – corticosteroids, application of immunomodulators (tacrolimus, pimecrolimus), disinfecting rinses for mucosal lesions, local anesthetics.
- General treatment for extensive forms – corticosteroids or retinoids.
