At Lichen planus, also known as lichen planus, is a non-contagious, chronic inflammatory disease of the skin and mucous membranes that is relapsing. Itchy nodules develop, which are particularly common on the crook of the wrists and the hollow of the knees, on the upper body and on the soles of the feet. But other parts of the body such as the fingernails and mucous membranes around the mouth or genitals can also be affected. Whitish stripes on the mucous membranes, so-called Wickham stripes, are also typical. The incidence peak of the disease is between the ages of 30 and 60, with women being more frequently affected than men. Lichen planus is the most common idiopathic (unknown cause) skin disease worldwide.
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This article might also interest you: Lichen planus - causes, symptoms, therapy
The causes for the development of lichen planus are not fully understood, but it is believed to be one virus-induced autoimmune reaction or contact allergic reaction.
The human immune system normally fights pathogens and substances that are perceived as "foreign". In the case of nodular lichen, there is a lot to suggest that the immune cells mistakenly make their own body through certain triggers Keratinocytes (Horn cells) attack and destroy the skin. It is believed that certain genetic variations in the genome increase the risk Lichen planus to get sick.
In addition to a genetic component, viral infections are also suspected to be the cause of the disease. In particular, the hepatitis C and hepatitis B viruses seem to promote an outbreak of the lichen planus, and patients suffering from such a chronic infection are often affected by corresponding skin changes. Allergies are also associated with lichen planus and can sometimes trigger them: the later foci of the disease often develop in areas that are already inflamed by a chronic allergic reaction. An outbreak of the disease can also be triggered by external stimuli such as scratching, rubbing or pressure on the skin (Koebner phenomenon).
$config[ads_text2] not foundA connection with the use of certain medications, such as beta-blockers, painkillers or antibiotics, is also discussed. However, these factors are not certain.
The doctor can usually diagnose lichen planus by examining it with the naked eye. In addition to the surface of the skin, the oral mucosa is also examined, as this is often also affected by the nodular lichen. Typical are small skin nodules (papules) and a net-like white streaking of the nodules and mucous membranes. This striation is particularly evident after some cooking oil or water has been dripped onto the affected areas.
When in doubt, the diagnosis is confirmed by microscopic analysis of tissue samples. Lichen planus is characterized by a thickening of the uppermost skin layer (hyperkeratosis) and a patchy thickening in the granular layer of the skin (hypergranulosis). This leads to the net-like white stripes. With the help of a special color, antibodies are made visible that are deposited under the epidermis. Special immune cells can also be found there, which are responsible for the inflammation.
Furthermore, blood tests, especially with regard to a hepatitis B or hepatitis C infection, are very useful. These findings ultimately confirm the diagnosis of lichen planus.
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The accompanying symptoms of lichen planus are very diverse and, in addition to the skin, can affect different parts of the body, such as the mucous membrane, hair or fingernails. Inflammatory, sharply defined reddish or brownish nodules and spots appear on the skin (Papules) that itch badly. These nodules are found primarily on the flexors of the wrists, lower legs, lower back, and squats. Since scratching the nodules is extremely painful, there are no scratch marks despite the severe itching. The affected areas can be next to the brownish one Hyperpigmentation fine milky white stripes (Wickham Stripe) exhibit. The spots often form small groups, which eventually turn into larger skin changes (Plaques) and connect with a strongly thickened, yellowish horny layer (Hyperkeratosis) are covered.
$config[ads_text2] not foundIf the mucous membranes are affected by the lichen planus, it is called Lichen planus mucosae. The foci of inflammation are typically covered with a clearly visible, net-like white coating. The areas can be completely painless or burn with a sharp burning sensation. In men, these changes appear, apart from the oral mucosa, mainly on the glans. Women have the typical changes, especially at the entrance to the vagina.
In addition to the skin and mucous membrane, the hair can also be affected (Lichen planus follicularis or planopilaris). Most of the time, this form of nodular lichen occurs on the body hair on the upper body and thighs, and sometimes the scalp is also affected. Small horn plugs form in the area of the hair follicles, which causes the hair to die and fall out. The affected areas feel very rough and the skin flakes off more. In the course of the disease, hair is lost and scarred, bald spots appear.
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Lichen planus can also affect fingernails and toenails and become brittle, shortened and grooved.
At Lichen planus mucosae In addition to the oral mucosa, the lateral parts of the tongue are usually affected. The changes in the mucous membrane can lead to pain, burning and open spots. Patients complain of dryness and a "furry feeling" on the tongue, and occasional taste disturbances.
Also read the article: Oral lichen planus.
The oral form of lichen planus is one of the most common diseases of the oral mucosa. The disease can be isolated or combined with Lichen planus occur on the skin. Autoimmune processes in the mucous membrane are suspected to be the cause, but dental materials (e.g. amalgam) or certain medications can also influence the lesions of the mucous membrane in the context of the nodular lichen.
There are two forms of oral Lichen planus mucosae: on the one hand the white or reticular Form in which the nodules are covered with a whitish film that cannot be wiped off, and on the other hand the red or erosive Shape. The latter occurs more frequently, is characterized by extensive erythema and erosions, and can be very painful.
The burning skin changes are more persistent in the area of the oral mucosa than on the skin. In addition to the mouth, tongue, gums, and cheek lining, the esophagus and larynx can also be affected. The typical whitish one Wickham Stripe is much more pronounced than in the case of the skin licheniformis. The changes in the mucous membrane may be painless or burn very badly, causing great pain for the patient when eating or during oral hygiene.
The mucous membrane of the genital area is less common Lichen planus mucosae affected than the oral mucosa. Changes in the mucous membrane occur in men in the area of the glans or in women at the vaginal entrance and on the inside of the labia. They are clearly visible and shimmer slightly in the light. The skin looks dry and tense. There may be individual nodules or coherent white plaques. Itchy and burning lesions develop, which lead to problems urinating and having sexual intercourse.
The fingernails can also be affected by lichen planus. It comes to one Longitudinal corrugation of the nail, which can split completely in the further course of the disease. The nail plates shorten and fray. The nodular lichen leads to the fact that the nail becomes thinner and thinner and in the worst case can fail completely. When the nail fails, the nail bed grows together with the cuticle and bulging scars develop.
$config[ads_text1] not foundThe treatment of lichen planus takes a long time and is not always successful. Usually, however, the disease is self-limiting and heals spontaneously on its own, but there are also more serious courses that absolutely require treatment. It is important to avoid scratching or rubbing the skin, as this worsens the symptoms and leads to pain.
For the therapy of lichen planus, the affected skin areas are treated locally with the glucocorticoid cortisone, which is administered in the form of creams or ointments for a short time. The treatment can be open or under a bandage. Alternatively, vitamin A supplements (retinoids) can be used.
Stubborn nodules can be injected directly with a cortisone solution by the doctor. Very keratinized lesions are also treated with salicylic acid. In combination with cortisone therapy, irradiation with UV light (PUVA therapy) accelerate wound healing and thus lead to a significant improvement in the lichen planus. In such a case, active ingredients are also used that dampen the immune system and thus alleviate the autoimmune inflammation (immunosuppressants). These include, for example, tacrolimus or cyclosporine.
To treat severe itching, the doctor can prescribe antihistamines, which render the body's own messenger substance histamine ineffective and thus help against the itching. At Lichen planus mucosae alleviate Local anesthetics the severe burning of lesions of the mucous membrane, in addition, nicotine and spicy foods should be avoided. Non-drug measures, such as cooling the skin with moist compresses or gel pillows, also relieve itching.
According to WHO is Lichen planus as Precancerous disease that means that the skin changes are associated with an increased risk of cancer. Therapy-resistant foci can become one after years Squamous cell carcinoma develop. However, this is very rarely the case. Nevertheless, a dermatological follow-up is recommended in the case of stubborn papules in order to detect any malignant degeneration at an early stage and, if necessary, to remove it surgically.
Homeopathy offers alternative treatment options for lichen planus. By taking homeopathic drops, the itchy foci of inflammation can recede and the course of the disease can be shortened. Schüssler salts and Bach flowers can strengthen the immune system and thereby have a positive effect on the disease.
In addition, from a homeopathic point of view, the remedies “Natrum muriaticum”, “Arsenicum album” and “Anacardium” can help. The recommended basic treatment is three globules with a potency of C5, alternating daily.
However, the individual homeopathic treatment should be carried out and supervised by a therapist.
Usually the disease heals after a period of spontaneously on its own for several months, with an average duration of one to two years. However, since the symptoms are very uncomfortable and the patients suffer from burning and itching, many sufferers undergo therapy. Through a treatment it comes within 9 to 18 months to a healing of the skin changes. Relapses occur in around 10-15% of patients several years after the lichen planus has healed.
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