Lichen ruber planus is a skin disease commonly known as nodular lichen. The disease is manifested by inflammation that causes skin changes and is accompanied by severe itching.
What is lichen ruber planus?
Lichen ruber planus owes its name to the typical formation of nodules on the skin. These nodules occur both sporadically and in dense clusters. In addition to the nodules, the skin usually also forms light-colored stripes on the surface, which are arranged in a net-like pattern. These stripes are also called Wickham stripes in medicine. The disease occurs on different parts of the body. Frequently, nodular lichen affects the mucous membranes, especially the oral mucosa. External skin areas that are often affected are shins, ankles and the backs of the feet. Sometimes the scalp or nails are also affected. The disease occurs comparatively rarely. It mainly affects middle-aged people, approximately between 30 and 60 years of age. It is assumed that nodular lichen is an autoimmune disease. However, this assumption is not certain, since the trigger of the disease has not yet been identified.
Causes
The causes responsible for the onset of nodular lichen are not known. It can only be observed that lichen ruber planus can be triggered or aggravated by mechanical irritation or skin infection, as is typical of many skin diseases. Disease flare-ups can also be caused by certain drugs or chemicals. The disease also occurs more frequently after viral diseases and brings out the typical skin changes. These could be traced back to an inflammation of the skin, which in turn is triggered by certain defense cells of the immune system below the epidermis, when these attack the epidermis and dissolve the lowest cell layer. Based on this, it is assumed that lichen ruber planus is an autoimmune disease. However, why these cells react in this way cannot yet be explained.
Symptoms, complaints, and signs
Nodular lichen can cause symptoms on the skin, skin appendages (for example, hair and nails), and mucous membranes. Typically, pale, usually bluish nodules form in lichen ruber planus. These are initially small and reach a size of two to twelve millimeters. In the course of the disease, several nodules combine to form a large nodule or raised skin spots. The papules have a fine surface characterized by the so-called Wickham stripes. They cause varying degrees of itching. Lichen ruber planus develops predominantly on the ankles, sacrum, lower legs, and wrist flexures. In the acute form, lichen ruber planus develops into a rash over the entire body. One in ten patients notices thinning or splitting of the nails in the course of the disease. Rarely, the nails fall out permanently. Hair loss may also occur, although this is usually limited to certain areas. Crusting forms on the scalp, and there is increased dandruff. In one third of cases, the mucous membranes are involved. Then conspicuous streaks develop in the area of the mucous membranes, as well as diffuse, mostly whitish areas. In individual cases, the tongue, gums, cheek pouches and lips are affected. Nodular lichen in the genital area causes mucosal changes in the glans or vaginal entrance, respectively.
Diagnosis and course
Based on the typical skin changes, the diagnosis of lichen ruber planus is easy to make. To confirm the diagnosis, physicians usually perform a blood and tissue examination. By examining the tissue sample, a so-called hyperkeratosis and a focal granulosis of the epidermis can be detected in lichen ruber planus. This is a disease-specific thickening of the epidermis. In addition, the identification of defense cells and antibodies underneath the epidermis can be used to conclude with certainty that there is lichen ruber planus. Even if lichen ruber planus is not treated, in most cases the disease subsides for no apparent reason. Often, the inflammation of the skin is completely healed after only 6 months. In 10 to 20 percent of cases, however, the disease recurs after a few years.In other cases, the disease does not resolve on its own, and treatment by the doctor is necessary. Even if the prognosis is good, medical treatment is advisable, since the itching causes many of the nodules to be scratched open, which often leads to scarring. In the case of scalp disorders, there is also a risk that the hair follicles in the affected areas of the skin will be destroyed and the hair in this area will go out completely. In rare cases, there is also loss of diseased nails. In the case of diseases of the mucous membranes, serious consequences may occur in the form of malignant tumors. Even though these cases are rare and tumors usually appear only after years of disease with lichen ruber planus, treatment by a medical professional is advisable to reduce the risk of complications.
Complications
In most cases, lichen ruber planus causes various symptoms on the patient’s skin. These can have a very negative effect on the aesthetics of the affected person and not infrequently lead to inferiority complexes or reduced self-esteem. The patients suffer mainly from papules on the skin and from a strong itching. The itching can also spread to neighboring regions and cause discomfort there as well. Furthermore, reddened stripes are formed on the entire skin. The quality of life of the affected person is significantly reduced and limited by lichen ruber planus. The skin also thickens, which also leads to aesthetic complaints. Itching may be intensified by scratching. Likewise, scratching not infrequently leads to the formation of scars. The treatment of lichen ruber planus usually takes place with the help of ointments and creams. No particular complications occur. However, it is not uncommon for patients to suffer from caries and require appropriate treatment. The patient’s life expectancy is usually not affected or reduced by lichen ruber planus.
When should you see a doctor?
When skin changes and other signs of lichen ruber planus appear, patients should talk to their primary care physician. If there are other signs of disease, it is best to consult a doctor within the same week. Changes in the hair, nails and mucous membranes indicate a pronounced form of nodular lichen, which must be urgently clarified. People who regularly take medication (such as painkillers and antibiotics) and diabetes patients are among the risk groups. Like patients with psoriasis and existing infections, these should involve the doctor if there are signs of a serious condition. If lichen ruber planus is treated early, it resolves quickly. Therefore, with symptoms or a concrete suspicion, a doctor should be informed in any case. This is especially true for people who repeatedly notice open areas in the skin and mucous membranes or who have already suffered from nodular lichen in the past. Affected people can talk to their family doctor, dentist or a dermatologist. The skin changes can cause psychological problems, which are best discussed with a psychologist.
Treatment and therapy
No treatment is needed for lichen ruber planus if the condition resolves on its own. Nevertheless, symptoms are usually treated to relieve affected individuals of discomfort. Usually, cortisone ointments and cortisone patches or ointments containing tar are prescribed to help regenerate the skin and relieve itching. In severe cases, medications in the form of cortisone crystal solutions are injected. These are used especially in cases of extensive disease and are usually accompanied by oral intake of vitamin A acid preparations. In addition, healing can be supported by local light therapy, such as photo-chemotherapy. This also stops the strong itching. Antihistamines are also prescribed for this. Even if it is suspected that lichen ruber planus is an autoimmune disease, it is not automatically treated with immunosuppressants. However, in rare cases, the use of these drugs is still necessary. Treatment of severe diseases that do not heal on their own is usually tedious and time-consuming and associated with pain for patients.Treatment of the mucous membranes proves to be particularly difficult, as tooth decay and dentures can repeatedly cause irritation, which is counterproductive to the healing of lichen ruber planus.
Outlook and prognosis
Basically, the manifestations of lichen ruber planus (nodular lichen) persist for a prolonged period of one to two years and then resolve on their own. However, the period of time until the conspicuousness subsides again can also be significantly shorter or even longer. In many cases, even after the healing of the nodular lichen, slight changes such as pigmentary disorders still appear. As a rule, no scars are to be expected with lichen ruber planus – in contrast to lichen ruber verrucosus (large infestation of the lower leg). In general, there are hardly any known serious consequences due to the disease. Sometimes the nodular lichen can progress from the acute to the chronic form and then persists for decades. Even after healing, recurrence must always be expected. Although there is still disagreement among scientists, according to the WHO (World Health Organization), lichen ruber planus is a precursor of precancerous skin cancer when it comes to diseases in the oral cavity. However, only very few patients with nodular lichen also develop oral cancer. However, since the possibility of developing cancer cannot be ruled out, regular check-ups should be performed at intervals of a few years. If patients who have already suffered from nodular lichen notice changes in the mouth, they should see a doctor immediately to rule out oral cancer or at least to treat it at an early stage.
Prevention
Because it is impossible to say what causes lichen ruber planus, there are no measures that can be taken to prevent the disease. However, patients who have had lichen ruber planus before are advised to avoid skin irritation, take great care with oral hygiene, and visit the dentist regularly to minimize the risk of another outbreak of lichen ruber planus.
Follow-up
The disease lichen ruber planus can usually lead to various complaints and complications, although the further course can vary greatly and in many cases depends on the time of diagnosis and the exact manifestation of the disease. Most affected individuals suffer from various skin complaints as a result of lichen ruber planus. Aftercare focuses on good management of the disease, as the external appearance is usually affected and sufferers feel ashamed of it. They should avoid excessive sun exposure, even if it is still unclear what causes the disease to develop. Regular visits to the treating physician provide information about the healing process and safely prevent further complications. In most cases, the disease does not negatively affect or reduce the life expectancy of the affected person.
What you can do yourself
Lichen ruber planus does not always need to be treated. Often, the disease regresses on its own. Nevertheless, symptoms may develop that require medical clarification. In the case of mild symptoms, a change in diet often helps. Exercise can also strengthen the immune system and thus help heal nodular lichen. However, good personal hygiene is also a prerequisite for this. The affected areas must be cleaned daily, and care products containing irritating substances should not be used. In case of severe symptoms, special cortisone ointments from the pharmacy can be used. Mild skin changes can in many cases be reduced with homeopathic remedies such as calendula ointment or a bath with medicinal herbs. If these measures have no effect, a doctor must be consulted. It is possible that there is a serious cause underlying the condition, which must first be diagnosed and treated. If the nodular lichen should cause psychological problems, a conversation with a therapist is indicated. The affected person should confide in a family member or a friend and go to the doctor together. However, the most important self-help measure for lichen ruber planus is the avoidance of mechanical irritants. If possible, sufferers should not wear irritating clothing and should not scratch the lichen.
