The different forms

Lichen ruber planus is the most common form of nodular lichen and occurs in both males and females. The disease manifests itself by small reddish nodules with clear boundaries, which are accompanied by inflammation and itching. These so-called papules occur mainly in the area of the flexor side of the wrist, the lower back, the knee, and the skin of the lower leg and forearm.

The exact cause of lichen ruber planus is still unknown. So-called autoantibodies are one approach to explain the lichen. These are proteins of the human immune system, which in this case normally recognize and mark foreign substances.

This enables immune cells to eliminate these invaders quickly and effectively. However, if these antibodies are disrupted in an autoimmune disease, the body forms antibodies against the body’s own tissue and damages it. A direct method to cure Lichen ruber planus does not exist at present.

Fortunately, however, the papules disappear after a few months by themselves. The therapy is therefore mainly aimed at alleviating the symptoms of the skin disease. This is usually done with cortisol therapy.

A healthy diet, radiation therapy and avoiding frequent stress also have a positive influence on recovery. Furthermore, despite itching, one should not scratch oneself in order to avoid additional inflammation. It is also important to know that Lichen ruber planus can occur in relapses.

This means that even after successful treatment and disappearance of the symptoms, the disease can reappear at a later time. In this case the therapy starts again. Frequently, skin ulcers, as they occur with lichen ruber planus, are associated with cancer by laypersons.

In the case of nodular lichen, however, this is not true, as the papules neither grow into foreign tissue nor spread throughout the body. Despite the harmless course of the skin disease, a doctor should always be consulted to exclude related diseases. Lichen ruber exanthematicus is another variant of Lichen ruber.

It often appears on the typical body parts that are affected by this skin disease. In this case, there may be mucous membrane and nail involvement, but this is not mandatory. Characteristics are reddening of the skin and elevations of the skin due to inflammatory processes.

In technical jargon, this is referred to as an erythemaopapular character. The elevations of the skin are called nodules or papules. In lichen ruber exanthematicus, these can be hexagonal.

Sometimes whitish streaks can also appear on the skin or mucous membrane. They are a sign of the widening of a certain skin layer of the epidermis. These stripes are called Wickham stripes.

The diagnosis is often a gaze diagnosis. Lichen ruber exanthematicus is one of the most common skin diseases. Men are affected more often than women.

The cause has not yet been completely clarified. Lichen ruber exanthematicus is treated with antihistamines, with topical steroid creams and, if necessary, with a surgical procedure, an occlusion. In addition, tar is used for treatment and an injection of steroid crystal suspension is performed.

In some cases, radiation is also performed. Acitretin, chloroquine, azathioprine, ciclosporin and DADPS are used medicamentously. The lichen ruber mucosae is a chronic recurrent disease of a mucous membrane, but mostly of the oral mucosa.

Mucous membranes are found in various parts of the body, including the intestines, nose, uterus and mouth. Their function is to provide mechanical protection of the underlying organ, as well as secretion and absorption of substances.The mucous membrane (mucosa) lines cavities in the body and is covered by a layer of mucus – hence its name. A defect of the mucosa can lead from loss of function to the death of the affected organ.

Lichen ruber mucosae can best be translated as “nodular lichen of the mucosa”. The cause of Lichen ruber mucosae is the subject of research, a drug-induced or autoimmune process is suspected. The therapy of the lichen ruber mucosae is also here long and difficult.

The word “verrucosus”, from the Latin for “warty”, describes this subform of the lichen ruber relatively aptly. It occurs preferentially on the extensor sides of the lower legs and less frequently on the back of the hand and is considered to be particularly resistant to therapy and thus very tedious. In most cases, the disease lasts no less than 5 years.

Lichen ruber verrucosus is a nodular to wartlike disease of the skin: The nodules can occur individually or in small groups and range in size from a few millimeters to 3 centimeters. In individual cases, several nodules can grow together and form warts up to 10 cm in size. The patient feels a strong itching, which among other things leads to scarring, which is associated with the healing of these nodules.

The therapy is complex and relies mainly on anti-inflammatory and anti-itching drugs such as glucocorticoids (cortisone). These are either taken orally or injected directly into the subcutaneous tissue at the affected area. External radiation therapy can also be used.

A therapy is important because if the lichen ruber verrucosus is not treated, it can degenerate into a carcinomatous form – i.e. there is a risk of skin cancer. Lichen ruber follicularis (acuminatus) often occurs on the hairy parts of the body. It is characterized by multiple, pointed conical elevations on the hair follicles.

They often show themselves in the form of a rash with unclear boundaries. Usually only a mild itching occurs. Often the scalp is affected.

The formation of the described papules prevents the newly growing hair from reaching the surface. This can cause hair loss and scarred baldness in the course of lichen ruber follicularis. The diagnosis is made on the basis of clinical signs and by microscopic examination of the area.

Differential diagnostic the doctor delimits a Leucoplacia nicotinica, a candiosis, lupus erytehrmatodes, contact allergy and secondary syphilis. Lichen planus can also occur in the genital area. This must be distinguished from a lichen sclerosus et atrophicus.

In comparison to this, a lichen planus is less frequent in the genital area. In most cases a lichen planus genitalis is based on a hormonal imbalance. This can happen especially in phases of a hormonal change.

In women, this can be the case for example during pregnancy. Lichen ruber planopilaris is a chronic skin disease that can lead to atrophy of the hair follicles and baldness. The cause is still unknown.

It is believed to be a chronic disorder of the cornification of the hair follicle epithelium. The subsequent destructive processes probably lead to destruction of the hair follicles and hair shaft. A loss of cytokeratin 15-positive stem cells has been observed.

The connection to other diseases like keratosis pilaris, follicullitis decalvans and lichen planus follicularis is unclear. In most cases, lichen ruber planopilaris occurs in middle age. Women are more frequently affected than men.

The disease usually manifests itself in the lateral and frontal part of the head. The back of the head is less frequently affected. The clinical picture is similar to the clinical picture of Lichen ruber follicularis. In addition, the extensor sides of the upper arms, thighs, oral mucosa and nails may also be affected. The microscopic image is used for diagnosis in addition to the visual diagnosis.