What does it look like
- Flat shiny nodules 2–5 mm, violet-red or lilac in color, with an indentation in the center
- On the surface there is a white mesh pattern (Wickham mesh), especially noticeable when wet with oil.
- Typical localization: flexor surfaces of the forearms, wrists, lower legs, lower back
- Severe itching, often painful
- The appearance of new rashes along the scratch lines (Köbner phenomenon)
- In the oral cavity: white lace lines on the mucous membrane of the cheeks, sometimes erosions - burning with spicy and hot foods
- On nails: thinning, longitudinal grooves, splitting, up to complete loss of the plate
- On the head: areas of scarring baldness
Reasons and provocateurs
The exact cause is unknown; We are talking about an autoimmune reaction. But there are factors that trigger or support it, and the search for them affects the outcome.
- Chronic viral hepatitis C - testing is recommended for all patients
- Medicines: some antihypertensives, antimalarials, NSAIDs, gold preparations
- Dental materials - amalgam fillings, metal crowns for mouth lesions
- Stress and chronic fatigue
- Contact with chemical developers and dyes
Diagnostics
- Осмотр дерматолога — картина обычно достаточно характерна.
- Дерматоскопия — выявляет сетку Уикхема.
- Биопсия кожи или слизистой — при нетипичной картине и обязательно при эрозивной форме во рту.
- Анализ на гепатит C и печёночные показатели.
- Ревизия принимаемых лекарств и стоматологического статуса.
Treatment
- Topical glucocorticosteroids are the basis for skin rashes
- Calcineurin inhibitors - for the face, folds and oral mucosa
- Systemic glucocorticosteroids for a short course - for common and severe forms
- Antihistamines to reduce itching
- Phototherapy (UVB, PUVA) - for common forms
- If the mouth is affected: rinses, gels with anesthetic and steroid components, replacement of traumatic fillings and crowns
- Cancellation or replacement of the provoking drug together with the attending physician
Эрозивная форма в полости рта требует регулярного наблюдения: на её фоне повышен риск злокачественной трансформации. Любая язва, не заживающая более 2 недель, должна быть осмотрена и при необходимости биопсирована.
Course and prognosis
Skin rashes in most patients resolve within 1–2 years, leaving brownish spots for a while - these are not scars, they gradually fade. Forms with damage to the oral mucosa, nails and scalp are more persistent and require long-term management. Relapses are possible, especially under stress.