DEPRIVE RED FLAT (lichen ruber planus; synonym deprive of Wilson) — the dermatosis of not clear etiology which is characterized by monomorphic pruritic papular rash on skin and also damage of mucous membranes, is more rare than nails. F. Geb a swarm as lichen ruber, in 1869 — Wilson is for the first time described in 1860 (W. J. E. Wilson) as lichen planus, in 1877 — M. Kaposha as lichen ruber planus. Makes apprx. 1% of all skin diseases. Are ill preferential adult at the age of 30 — 50 years.
The etiology and a pathogeny
Exists several theories of development of L. to. item. The neurogenic theory is based on identification of disturbance of processes of excitement and braking in c. N of page, provocative role of a mental injury, defeats of century of N of page, dystrophic changes of the peripheral terminations of nerve fibrils in skin, etc. The endocrine theory is based on detection of dysfunction of bark of adrenal glands, increases in excretion of catecholamines; it is supposed that nervous and endocrine breakdowns are rather factors pathogenetic, than etiological. The infectious theory assumes as the activator the filtered virus, vegetans vnutrikozhno; at a submicroscopy are revealed morfol, the structures similar to a virus, and also with mycoplasmas and bacteria, however it was not succeeded to allocate the activator. The Infektsionnoallergichesky theory recognizes that the cells of epidermis affected with a virus induce antibodyformation and development of autoallergichesky reactions * leading to damage of a basal membrane and cells of a basal layer with formation of cellular infiltrates in a derma. A certain significance is attached to hereditary predisposition. Also the possibility of a provocative role of an endointoxication is allowed from went. - kish. path, some medicines (arsenic, streptomycin, synthetic anti-malarial drugs, etc.) » profvrednost (trichloroethane, a paraphenylenediamine, etc.), changes of reactivity of an organism and so forth
Are observed a hyperkeratosis, uneven granulez, an acanthosis, vacuolar dystrophy of cells of a basal layer of epidermis. The basal membrane is destroyed by places, tonofibrils lost the electron density, the correct arrangement and communication with desmosomes which, as well as semi-desmosomes, are destroyed. In kernels of cells of epidermis — lamellar and granular inclusions. Dermo-epidermalnaya the border is greased with the lymphocytic infiltrate which is accurately delimited from below with single neutrophils, and is later with impurity of fibroblasts and chromatophores. Nipples of a derma are dome-shaped. Nerve terminations with the phenomena of dystrophy. In places cracks between epidermis and a derma are visible.
Damage of skin is characterized by the polytone, accurately delimited, slightly towering over the level of surrounding skin reddish-violet plotnovaty papules to dia. 0,5 — 4 mm, with a brilliant surface and umbilicate impression in the center (tsvetn. fig. 1). Gradually they get a brown, and then brown shade. Development of papules slow, progressing. Merging, they form the polycyclic mosaic, slightly shelled plaques to dia, to 30 mm. On separate plaques the grayish-white mesh drawing caused by an uneven granulez which especially well comes to light during the greasing of papules vegetable oil — a grid of Uikhem (tsvetn is swept up. fig. 2). Rashes are symmetrized, is scattered or grouped on flexion side of wrists, forearms, the bottom of a stomach, a waist, the lower extremities, is more rare on generative organs, a neck, palms and soles, is very rare on a pilar part of the head. L. to. the item is followed by an itch.
There are a wedge, kinds of L. to. item of skin.
1. Ring-shaped L. to. and. it is formed at group of papules in a ring to dia, to 20 mm or with a centrifugal growth of separate plaques with slightly sunk down and pigmented center (tsvetn. fig. 5) is more often on skin of a scrotum and a penis.
2. The Serpiginozny form — papules are grouped in arches, semicircles and other figures.
3. Linear (zoniformny) L. k.p. — papular elements are located linearly, usually on the course of nervous trunks on a trunk or on the lower extremities (tsvetn. fig. 3).
4. Deprive flat hair (follicular) — small papules are localized around mouths of follicles on a pilar part of the head; often comes to the end with an atrophic alopecia (see. Littla — Lassyuera a syndrome ).
5. The erythematic form arises suddenly on a considerable part of an integument in the form of a malinovokrasny erythema on a trunk and extremities with insignificant hypostasis and an easy peeling; papular elements are difficult distinguishable before reduction of intensity of an erythema.
6. Pemfigoidny L. to. items — in addition to typical papules, are formed the subepidermal bubbles with serous or hemorrhagic contents located on a surface of papules or on not changed skin; quite often arises at patients with malignant tumors of internals, being a paraoncological dermatosis.
7. Hypertrophic (warty) L. to. the item — accurately delimited violet plaques with the expanded mouths of hair follicles and sweat glands corked with the horn traffic jams covered with thick asbestovidny scales (tsvetn. fig. 6); it is characterized by a persistent current and preferential localization on skin of shins.
8. Flat L. to. the item — the hemispherical, slightly shelled papules to dia, to 10 mm, localized usually on skin of shins.
9. Korallovidny L. to. the item — the flattened papules up to 10 mm which are located in the form of beads and alternating with sites of a hyperpegmentation (meets very seldom).
10. Pigmental L. to. the item — the expressed hyperpegmentation developing practically along with emergence of papules (meets seldom).
11. Sharp-pointed L. to. the item — the follicular sharp-pointed, cone-shaped small knots, acervate on limited sites, which were horny at top, to dia. 1 — 3 mm to the touch reminding a surface of a grater.
12. Atrophic L. to. the item (a synonym secondary sclerosing lichenins) — atrophic changes of skin on site papules (meets seldom).
13. Acute sharp-pointed L. to. the item — small bright red conic, is more rare spherical, the papules against the background of an erythema and hypostasis arising sharply and within several days the erythroses covering all body with formation (tsvetn. fig. 4); typical papules at the same time can be found only by means of a magnifying glass. This option can pass in 1 — 2 month into a usual hron, a form.
Damage of mucous membranes is observed almost at a half of sick L. to. the item also arises along with an enanthesis or separately. Most often on a mucous membrane of cheeks, backs of the tongue, are more rare than the sky, a red border of lips, a vulva, an internal leaf of a prepuce and on a balanus there are rashes in the form of a grayish-white lacy grid (tsvetn. fig. 7), branchings, rings, roundish islands of opal color. Exudative and hyperemic, veziko-violent, warty and erosive and ulcer forms are less often observed (tsvetn. fig. 8 — 10). The last sometimes develops at patients with a diabetes mellitus and idiopathic hypertensia — Greenspan's syndrome. Some authors allocate also atrophic, or sclerous, the form representing, apparently, option focal sclerodermas (see), and also infiltrative periglandulyarnuyu and pigmental forms L. to. item.
Damage of nails is observed at 10 — 15% of sick L. to. the item is also characterized by formation of longitudinal grebneobrazny furrows, opacification, thinning and deepening of nail plates which become brittle and collapse.
the Diagnosis in the most part of cases is not complicated and the wedge, pictures is put on the basis. Sometimes apply some tests to more accurate identification of characteristic papules. So, e.g., after greasing of papules vegetable oil the grayish lacy grid comes to light, after the warming compress of a papule bulk up, get a nacreous shade (Pospelov's symptom). In an acute stage of a disease isomorphic reaction of Kebner is often observed (see. Kebnera phenomenon ), arising in 7 — 10 days on site of traumatization of skin.
An enanthesis should be differentiated with papules in the secondary period of syphilis, at lichenoid parapsoriasis (see), with flat warts (see), knotty prurigo (see); on mucous membranes — with leukoplakia (see), candidiasis (see).
Rest, exception of stimulants (coffee, spices etc.), heat baths, hypnotherapy, electrosleep, sedative drugs, as necessary tranquilizers, elimination of the centers of a focal infection (tonsillitis, antritis), antihistaminic drugs, vitamins of group B, tocopherolacetate, Retinolum acetate. Report about effective use of a biyokhinol, drugs of hydrazide isonicotinic to - you, antibiotics. In hard persistent cases of a current of L. to. items are shown corticosteroids. Outwardly — at a severe itch in an acute stage of process — rubdowns of 2 — 5% water or spirit solution of resorcin or 0,1% solution of menthol with 1% of Chlorali hydras; corticosteroid ointments, further — tar naftalanovye ointments, UF-radiation, diadynamic currents. At a warty form L. to. items of skin apply applications of 33% trichloroacetic to - that, a May apple Ling, dry ice, liquid nitrogen, a scraping an acute spoon of Folkmann, destruction of the centers of defeat by a thermocauter, an obkalyvaniye chemical opsin, corticosteroids. At damages of mucous membranes of a mouth delete incorrectly driven dentures, carry out vacuum therapy.
The forecast and Prevention
the Forecast for life favorable. The average duration of a disease of 8 — 12 months, but on mucous membranes of a rash can keep within several years. Especially persistently the warty form L proceeds. to. item. A recurrence of a disease is possible. The malignancy of defeats on a mucous membrane of a mouth is very seldom observed (preferential warty form L. to. item).
Prevention: to avoid nerve strains, to timely sanify the centers of a local infection.
Bibliography: Bazyka D. A. and Bazyka A. P. Etiologiya, a pathogeny and therapy red flat depriving, Vestn, dermas, and veins., No. 11, page 58, 1977; The Multivolume guide to a dermatovenereology, under the editorship of G. T. Pavlova, t. 3, page 162, M., 1964, bibliogr.; Fishermen A. I. and Banchenko G. V. Diseases of a mucous membrane of an oral cavity, M., 1978, bibliogr.; Stoyanov B. G., Abramova E. I. ivaskovsky G. P. Feature of clinic of Pi of treatment red flat depriving of a mucous membrane of an oral cavity, Stomatology, t. 56, No. 4, page 14, 1977; T and d-zhibayevt. T. Krasny flat deprive, Tashkent, 1968, bibliogr.; Stein-lukht L. And., etc. Persotsil in therapy of patients with red flat is deprived, Vestn, dermas, and veins., No. 1, page 74, 1978; G e of t 1 e of W. Systematische Dermatologie und Grenz-gebiete, Bd 2, Lpz., 1972; J ohnson F. R. a. Fry L. Ultrastructural observations on lichen planus, Arch. Derm., v. 95, p. 596, 1967; L aufer J. et Kuffer B. Le lichen plan buccal, P., 1970, bibliogr.
H. A. Torsuyev; V. V. Vladimirov (tsvetn. fig. — 1, 5, 6).