Alles wat je moet weten over de huidziekte lichen planus

Epidemiology

Overall, lichen planus (LP) is thought to afflict between 0.5% and 2% of the world’s population.[7] Oral LP is reported as the most common form of LP.[7] Onset is most common in middle age, with the average age of onset being 50 to 60 and rarely presents in children.[8][9][10] Cutaneous LP appears to occur equally among the sexes, while oral LP is three times more common in women than in men.[8][11]

Erosive lichen planus is one of the many clinical presentations of lichen planus. The incidence of erosive LP has not been determined. Similar to other presentations of LP, erosive LP occurs most commonly between the 5th and 8th decades of life.[8] Women develop erosive LP at about twice the rate of men.[12] Erosive LP most commonly presents as painful ulcerations of either the oral or genital mucosa. Patients may present with ulcerations at multiple sites, in one study, 57% of patients with oral LP were also found to have vulvar LP.[13] In another study, 17.6% of patients with vulvar LP were identified to have the erosive subtype of LP.[14]

Histopathology

Diagnosis of erosive lichen planus is most often made based on a presentation with a typical history and clinical appearance. The biopsy of the lesion is usually performed when the diagnosis is in question or to rule out malignancy. As mentioned above, ulceration of the lesion may result in the absence of the characteristic lichenoid features on histology.[8]

Regardless of the location of the patient’s symptoms, full evaluation of the cutaneous and mucosal surfaces should be performed when lichen planus is suspected. Patients with lichen planus frequently present with manifestations in more than one location. A thorough review of other systems should also be obtained to identify any symptoms suggestive of mucosal involvement, such as esophagus, conjunctiva, urethra, anus, or larynx. Untreated erosive lichen planus frequently progresses to scarring and functional impairment, especially when undiagnosed and untreated.[26] Screening for an unknown diagnosis of hepatitis C should also be considered.

Discussion

Ocular LP is a rarely reported entity, with conjunctival LP reported in 1928 8 and LP of the eyelids in 1938.8, 9, 10, 11 It may occur in the form of pruritic violaceous papules of the eyelids, but, as in our case, may only present as irritation of the eye lids ( Table I ), 10 , 12 , 13 blepharitis, and eventually, keratitis. A review of the literature revealed 22 previously reported cases of ocular LP, with this case bringing the total to 23. Of the reported cases, 19 out of 23 (83%) affected individuals of the female gender, and 6 out of 23 (26%) had only ocular involvement of their LP.14, 15, 16

Table I

Common causes of eyelid dermatosis

Ocular LP can involve the eyelids ( Table I ), but can also involve the conjunctiva and lacrimal structures. Ocular LP can lead to irreversible damage to the surface of the eye and loss of vision. Conjunctival involvement can lead to cicatrization and subepithelial scarring ( Table II ) with involvement of the lacrimal structures leading to dry eye. Ocular LP rarely responds to local ocular therapy. 7 , 8 , 10

Table II

Common causes of cicatricial conjunctivitis

Wie krijgt het?

Iedereen kan lichen planus ontwikkelen, maar het wordt vooral gezien bij mensen tussen de 25 en 70 jaar oud. Bij baby’s en peuters wordt het vrijwel nooit gezien.

Er bestaat geen genezende therapie voor lichen planus. De klachten die de aandoening veroorzaakt kunnen doorgaans wel goed onderdrukt worden. Mogelijke behandel methoden zijn:

corticosteroiden voor de huid (‘hormooncremes’)
deze zijn doorgaans goed in staat de jeuk te onderdrukken
lichttherapie
UVB en PUVA lichttherapie -kuren kunnen poliklinisch worden toegepast in ernstiger gevallen van lichen planus.
ciclosporine
bij zeer ernstige vormen kan ciclosporine worden voorgeschreven. De kuren met dit middel, dat het immuunsysteem van het lichaam beinvloedt, duren meestal kort.
acitretine en prednison kunnen eventueel in ernstige, hardnekkige gevallen worden toegepast.