lichen sclerosus
Introduction
Introduction to hardened atrophic moss The lichensclerosis etatrophicus, also known as lichenalbus, lichenplanus morphoeicus or Csillage disease, is a cause of chronic atrophy of the skin that is not yet known. Disharmony, exogenous rheumatism caused. basic knowledge Sickness ratio: 0.05% Susceptible people: no special people Mode of infection: non-infectious Complications: pruritus constipation
Cause
Causes of sclerosis and atrophy
(1) Causes of the disease
The cause is unknown, because the disease occurs mostly in women aged 40 to 50 years old, and the young girl also has the disease, but it can be cured naturally during puberty, suggesting that it may be related to endocrine dysfunction. Some patients also have vaginitis, foreskin balanitis or new foreskin. A rash occurs after circumcision, indicating that it may be related to infection. Some patients have autoimmune diseases or autoantibodies. HLA-B21 and B40 are more common, suggesting that there may be autoimmune causes, and reports of family morbidity. , but did not get the final confirmation.
(two) pathogenesis
The pathogenesis is unclear and may be related to endocrine dysfunction, infection, autoimmune diseases, or the development of autoantibodies and family diseases.
Prevention
Hardening and shrinking moss prevention
Remove possible predisposing factors, avoid local irritation, treat vaginitis and cephalitis.
Complication
Sclerosing atrophic moss complications Complications pruritus constipation
In the female genital, atrophy, leukoplakia, atrophic area enlargement, urethral stricture, and some may turn into squamous cell carcinoma, males, often itching, rare cancer.
Symptom
Symptoms of sclerosing and shrinking moss Common symptoms Itching papules, blackheads, acne, sacral constipation, depression, scar, bloody blister
Both men and women can develop the disease, which occurs in women. The ratio of male to female is 1:10. The age of onset is more common in 40 to 50 years old, but it is also seen in children. Early skin damage often has no symptoms, and is not noticed. Damage is lentils-sized flat-top papules, round or irregular, pink, with obvious red edges, soft texture, and later developed into typical skin lesions, papules are porcelain white, ivory, hard texture, can be integrated It is plaque, clear in the boundary, central depression, embedded with black-headed acne-like horn plug, and after it is removed, it is a small pit-like depression. The central lesion is atrophied and thinned at the center, which can be fused into a clear white patch. The central spot of the white spot can be bullied. Or blood blisters, bullous lesions can form more millet rash after the regression, the atrophy becomes a micro-sag scar.
Skin lesions occur in the upper part of the trunk such as the supraclavicular fossa, chest area, armpit, two breasts, umbilical circumference, forearm and neck. The genitalia are more common, and those who occur in the vulva account for 50% to 75%.
Hairy female, more common in the labia minora, clitoris, around the anus, sometimes can extend to the inside of the femoral, can be single in the female yin, but also at the same time there is skin lesions, damage to ivory or waxy yellow flat solid papules, Sometimes fused into a piece, the surface horny hyperplasia, and visible angle plug, sometimes flushing, impregnation, erosion, small blisters, and even bleeding, can occur in the late stage of atrophy, leukoplakia, enlarged atrophy area, can make the urethral opening narrow, and some may It is converted into squamous cell carcinoma, the itching is obvious, there may be pain, difficulty in sexual intercourse, difficulty in urinating and constipation. Some people think that this disease is the same disease as kraurosis valvae, and may also be a female white lesion. Variants, which are common in male vulva, are mostly seen in the elderly, mostly suffering from phimosis or balanitis. The damage is basically the same as that occurring in the female genital area. The skin lesions occur in the inside of the foreskin and the glans, which are keratinized papules with clear boundaries. It is light white and can have parchment-like wrinkles. Skin lesions can also occur in the penis, scrotum and other parts. In severe cases, the urethral stricture can be developed, and the foreskin lacered and atrophied. Even disappeared, the foreskin hardening can not be turned up, or because the erosion and the glans adhesion, usually itching, rare cancer, it is considered that the disease and the blunt dry balanitis (blanitis xerotiva obliterans) or penis dry (kraurosi penis) for the same disease The course of the disease is slow and often lasts for many years. The damage of adults is mostly progressive, and the damage of children is reduced with age, and some of them are self-resolving at or before menarche.
Examine
Hardening and shrinking moss
Histopathology: hyperkeratosis, horny plug in the hair follicle and sweat gland, atrophy and thinning of the epidermal cell layer, disappearance of the nail process, liquefaction and degeneration of the basal cells, fissure formation between the epidermis and the dermis, and 1/3 collagen fibers on the dermis Edema and homogenization, capillary and lymphatic vessel dilatation, shallow elastic fibers of the dermis are reduced or disappeared, and mild lymphatic-based perivascular infiltration is banded or flaky, and late infiltration can be reduced or disappeared.
Diagnosis
Diagnosis and identification of sclerotic atrophy
diagnosis
According to clinical manifestations, combined with histopathology, a diagnosis can be made.
Differential diagnosis
1. Lichen planus: It should be distinguished from atrophic lichen planus. The onset of lichen planus is purple-red, itching is more, but hardening is not possible. The skin of the lichen planus is visible elsewhere. The histopathological findings are no connective tissue edema. And homogenization.
2. Female vaginal white lesion (leukoplakia vulvae): occurs in menopausal women, can also be found in young women, does not involve the lateral and perianal areas of the labia majora, does not occur atrophy, consciously itchy, histopathology shows granular layer changes Thick, irregular layer of acanthosis, visible keratinocytes.
3. morphea guttata or guttata scleroderma: This disease has many similarities with atrophic sclerosing moss, but hard spot disease is generally not higher than the skin, hardening Not obvious, the damage is small, the number is large, and scattered, the histopathology has no obvious hair follicle angle plug and basal cell liquefaction, inflammatory infiltration is not obvious.
