Lichen planus
Introduction
Introduction Lichen planus, the name of traditional Chinese medicine is "purpura", clinical is not uncommon, and the incidence rate has increased in recent years. Because of the ever-changing performance of their skin lesions, they are often misdiagnosed. Chinese medicine believes that this disease is a factor of yin and blood deficiency, spleen loses health and transport, lack of enrichment, re-feeling wind evil, rheumatism in the skin, stagnation in blood or due to liver and kidney deficiency, yin deficiency heat, virtual fire on the inflammation The mouth is sick. Lichen planogens occur in young people and adults. Because of the different symptoms of lichen planus, according to its incidence, rash morphology and arrangement characteristics, it is clinically divided into acute generalized lichen planus, chronic localized lichen planus, hypertrophic lichen planus, linear flat Moss, ring-shaped lichen planus, atrophic lichen planus, follicular lichen planus, blunt-headed lichen planus, bullous lichen planus, dripping lichen planus, erythematous lichen planus, palmar flat Moss, tropical lichen planus, isolated lichen planus, Rosary red moss, lichen planus, lupus erythematosus and Grahamittle syndrome. The common typical performance has been as described above, combined with histopathological examination and various characteristics, can be diagnosed.
Cause
Cause
(1) Infection factors:
Since the 1960s, many scholars have studied the relationship between this disease and microorganisms. Thyreason et al found a virus-like nuclear corpuscle in the lesional epithelial cells, which was thought to be a pathogenic virus, but electron microscopy showed that the nucleus was a cross-section of the nuclear membrane of the lesion, and the epithelial cells were not Heterosexual structures are not viral particles. Some scholars have observed the epithelial deep cell-like structure by electron microscopy. Therefore, it is thought that the bacteria invade the mucosal epithelium and the pathogenesis, but it is negated by the later scholars' research, because it is only found in the damaged epithelium of the erosive lichen planus, but only in the non-erosive type. Bacteria are found on the epithelial surface, so it is not considered to be a pathogenic bacterium of lichen planus.
(2) Mental and neurological factors:
Due to various reasons such as environment, family, work, personal life, etc., the physical and mental activities are affected, the spirit is traumatized, nervousness, anxiety, depression, etc., causing a series of changes in the body, such as psychological, pathological, biochemical metabolism, resulting in disordered disorders. disease.
(3) Endocrine factors:
There are many female patients with this disease, and the fluctuation of the condition is related to pregnancy, menopause and some drugs that affect endocrine function. In patients with estradiol, testosterone levels are much lower than normal.
(4) Trace elements:
In recent years, it has been noted that trace elements have specific physiological functions in the human body and their relationship with this disease. For example, in the mucosa of zinc-deficient mice, incomplete keratinization may occur, the acanthosis may be thickened, and the epithelium may have dysplasia. However, the serum zinc in patients with lichen planus is normal, and zinc supplementation has not achieved significant effects. Therefore, it is considered that the inferior keratinization of lichen planus is a non-essential secondary change. Manganese plays an important role in maintaining mitochondrial function and is related to its formation. These are to be confirmed by further research. When detecting trace elements in the hair of patients, it was found that zinc, iodine, etc. were lower than normal, and nickel was higher than normal.
(5) Systemic disease factors:
Patients with lichen planus are often associated with a variety of systemic diseases or symptoms. Many patients with pathogenesis and disease development are associated with certain systemic diseases, such as diabetes, hepatitis, and high blood pressure and digestive tract dysfunction.
(6) Local stimuli:
Different metal restorations form a potential difference in the mouth. In addition, the stimulation of the filling or the like may cause a mossy change in the oral mucosa. It has been reported that amalgam fillings cause lichen-like lesions, and a small number of patients may also develop allergic reactions to copper, zinc, silver, and the like. These may be delayed-type hypersensitivity reactions (type IV allergic reactions). Contact metamorphosis may be a local reaction caused by free mercury entering the mucosa and becoming an antigen.
(7) Genetic factors:
Some people have found that this disease has a family history tendency. Many scholars have carried out family disease research, but the pedigree analysis does not conform to the single gene inheritance law. Many studies have been conducted from HLA (human leukocyte antigen). The HLA-type gene carried in patients with familial lichen planus was significantly higher than that of non-familial lichen planus, suggesting that the incidence of lichen planus may be related to genetic factors.
(8) Immunological factors:
It is still not completely clear. According to the disease, the disease is fluctuating, repeated and there is inflammatory cell infiltration in the subepithelial lamina propria, mainly from the infiltration zone of T lymphocytes, so it is considered to be related to immune factors, and it is proved that these cells are not the result of local hyperplasia, but from the blood, It is now believed that lichen planus is immune to dysfunction, which may lead to susceptibility to an unidentified virus, and suggests that patients have humoral immune disorders.
Examine
an examination
First, physical examination
Taking a medical history gives us a first impression and revelation, and also guides us to a concept of the nature of the disease.
Second, laboratory inspection
Laboratory examinations must be summarized and analyzed based on objective data learned from medical history and physical examination, from which several diagnostic possibilities may be proposed, and further consideration should be given to those examinations to confirm the diagnosis.
Diagnosis
Differential diagnosis
Neurodermatitis:
The disease is associated with chronic skin inflammation, pathogenesis and neuropsychiatric factors and some external stimuli. Chronic, not prone to moist, easy to recurrent. Chinese medicine calls it "stubborn", "psoriasis", "photographing sores."
1. The basic damage is mostly round or polygonal flat papules fused into a piece. After scratching, the skin is thick, the skin groove is deepened, the skin ridge is uplifted, and it is easy to form moss. It is an important feature of this disease.
2. The skin lesions are flat papules with a tendency to gather, dry and firm, with normal or light brown skin and bright surface. The long-lasting pimples are fused into a piece, gradually increasing, and the skin is thickened and dried to form a striate pattern, often scratching to form skin moss.
3. Consciously paroxysmal itching, even more into the night, I don't know the pain. When the mood fluctuates, the itching increases.
4. The disease occurs in the back of the neck and on both sides, elbow fossa, armpits, cercaria, etc. When the rash is not extensive or limited to the above-mentioned parts, it is called localized neurodermatitis; the rash is widely distributed. Except for the parts involved in the restricted type, when the eyelids, scalp, trunk and limbs are involved in one part or the majority, it is called pan. Neuropathic dermatitis.
Nodular pruritus:
More common in adult women, it occurs on the side of the limbs and the back of the hands and feet. From the beginning, the number of reddish papules is gradually variable to the reddish-brown or taupe hemispherical nodules of soybeans to broad beans. The surface is rough and blemishes, paroxysmal itching, pigmentation and mossy changes due to scratching. Chronic course.
psoriasis:
Also known as psoriasis, psoriasis is a common chronic skin disease characterized by repeated multiple layers of silvery white dry scales on the erythema. Ancient medical books are also known as pine bark. Western medicine is called Psoriasis, commonly known as psoriasis, which is characterized by the appearance of papules of varying sizes, erythema, covered with silvery white scales, clear boundaries, and occurs in the scalp, the extremities and the back. More men than women. Spring and winter seasons are prone to recurrence or aggravation, while summer and autumn are more relieved.
