Lichen ruber planus

Lichen ruber planus belongs between erythemato-papulo-squamous dermatosis, whose  characteristic characters  are :


 * itching flat reddish brown papules around 1& thinsp;mm in diameter, waxy shiny,
 * typical histopathological finding,
 * disabilities mucous membranes, hair and nails.

Etiology
Etiology the disease is unclear. Participation is considered cytotoxic T-lymphocytes directed against antigens in the area basal membranes. Illness has connection with chronic hepatopathies (hepatitis C and hepatitis D) and administration drugs (beta - blockers ).

Clinical image
typical for lichen planus symmetrical sowing itchy, flat ,shiny ,polygonal ,reddish-brown papule. On the surface papule they can be sometimes visible Wickham's stria – whitish drawing, which is conditional hypergranulosis. After healing papule they persist hyperpigmentation.

 Predilection localization  are :
 * Lichen unguium.jpg parties wrist,
 * cross landscape,
 * insteps, ankles.

Clinical forms

 * Exanthematic form
 * Acts massive acute sowing petty cash papule mainly on hull which can go to erythroderma . He can be present asymptomatic whitish reticulated venation on buccal mucosa (up to half sick). At 10 % sick people occur and changes on nails


 * Lichen planus annularis
 * Speeches sometimes they can be grouped into rings. This form often affects genitalia.


 * Lichen planus mucosae
 * Manifests as painful erosions and scarring, especially around cavities oral and anu.

Lichen planopilaris
 * The emergence is characteristic follicularly bound and often confluent pointed hyperkeratotic red ones papule. He can lead to scarring alopecia.

Lichen unguium
 * Running out to thinning disc, deformation disk. Subungual hyperkeratosis they can lead up to total loss nails.

Lichen palmoplantaris
 * It is diffuse reddish-brown hyperkeratosis face and palm, sometimes with ulcerations


 * Lichen planus verrucosus
 * They arise verrucous elevated reddish brown bearings, often on shins.

Histopathological finding

 * Acanthosis, hypergranulosis , orthohyperkeratosis epidermis,
 * mononuclear striped infiltrate in the upper corium  penetrating into the lower ones parts epidermis, dermo- epidermoid the junction is not sharp, forming " teeth ". saws ",
 * vacuolar degeneration of keratinocytes in the basal layer, clusters cytoid corpuscles – Civatte corpuscles ,
 * shedding of melanin to the corium – here the melanin pigment is absorbed by macrophages ,
 * direct immunofluorescence demonstrates immunopositivity IgM and IgG.

Differential diagnosis

 * Psoriasis ,
 * pityriasis rubra pilaris,
 * medicinal exanthems ,
 * bullous dermatosis.

Therapy

 * Local – corticosteroids, application of immunomodulation  ( tacrolimus , pimecrolimus ), disinfectant lavages in the disabled mucous membranes , local  anesthetics.
 * Total treatment in extensive forms – corticosteroids or retinoids.

Related articles

 * Lichenification