Alles wat u moet weten over Lichen Planus als Huidziekte

Lichen ruber planus

De oorzaak is onbekend. Wel zijn er vele mogelijke verklaringen gegeven over de ontstaanswijze ervan.

We zien meerdere platte paars-rode bultjes die vooral voorkomen op de binnenkant van de polsen en de enkels, maar ook op de onderrug, en de nek. Op de scheenbenen en enkels ziet men soms dikke verharde plekken. Lichen planus kan echter op alle plaatsen van het lichaam voorkomen, zelfs op het behaarde hoofd. In ongeveer 20% van de gevallen geven de afwijkingen vrijwel geen klachten en zijn ze bovendien gering van omvang. In de andere 80% is jeuk de meest voorkomende klacht. De jeuk kan zeer hevig zijn. Lichen planus toont de zogenaamde “Koebner fenomeen”. Op de plaatsen waar hevig gekrabd is of een wondje is geweest ontstaat een typische lichen planus afwijking. Een vervelende plaats om lichen planus te hebben vormt de slijmvliezen. Vooral in de mond, aan de binnenkant van de wangen, op het tandvlees of de tong kan lichen planus zitten, vaak zonder dat men zich dat bewust is. We zien dan fijne witte lijntjes en stipjes. Vaak worden deze plekjes voor het eerst bij toeval opgemerkt tijdens een tandartscontrole of door de dermatoloog. Veel ongemak geven ook lichen planus plekken op de penis (eikel) en de vagina. Niet zelden gaan deze plekjes over in pijnlijke wondjes en zweertjes. In ongeveer 10% van lichen planus zijn ook de nagels aangetast. De veranderingen bestaan uit in de lengterichting verlopende ribbeltjes, gleufjes en spleten. In ernstige gevallen kan de nagel er zelfs afvallen en niet meer terugkomen.

KAN UIT LICHEN PLANUS IN DE MOND KANKER ONTSTAAN ?
Er bestaan momenteel tegenstrijdige berichten over de relatie van lichen planus in de mond en huidkanker. Tot nu toe zijn de bewijzen hiervoor echter niet overtuigend zodat we ervan moeten uitgaan dat lichen planus in de mond goedaardig is en blijft.

CLINICAL FEATURES

Vulval/vulvovaginal lichen planus

Vulval/vulvovaginal LP most commonly affects women in their late 50s or early 60s.[24] The affected group is mostly postmenopausal, and the disease has not been reported before puberty.[25]

The clinical forms of LP on the female genitalia are mainly erosive, papulosquamous, and rarely hypertrophic.[26] The presentation varies from subtle fine white interlacing linear papules/plaque in its mildest form to severe erosive disease leading to scarring. The classical cutaneous LP lesions are uncommon in the genital region. The hair-bearing areas (mons pubis and inner thighs) are uncommon sites for LP. On the labia majora, lesions may appear dusky red or reddish-brown instead of the typical violaceous colour of cutaneous LP. Occasionally, the hyperkeratotic variant exists as firm white papules/plaques with irregular borders and thickened irregular surface [ Figure 1 ].

Violaceous-whitish plaque with interspersed erosions

Erosive disease is the most significant and distressing form of Vulval LP. This most commonly involves the posterior vestibule and often extends anteriorly to the labia minora [ Figure 2 ].[25] Dusky erythema or erosions, surrounded by a typical white lacy border, are visualized in some cases interspersed with whitish areas. Severe long-standing erosive disease can cause loss of normal architecture with fusion of the labia minora, loss of interlabial sulcii, and burying of the clitoris. The erosive form is often associated with inflammatory vaginitis[25] which produces symptoms of vaginal discharge, pain, and burning during micturition. A per-vaginal examination may be extremely painful, and bleeding on manipulation/instrumentation can occur. Vaginal lesions have been variably reported to be present in 20%–58% cases of Vulval LP.[27,28] Adhesions often develop in long-standing disease andnarrowing/shortening or even total obliteration of the vagina is often the final outcome [ Figure 3 ].

Mouth lichen planus - inside cheek

By Ian Furst, CC BY-SA 4.0, via Wikimedia Commons

About half of people with a lichen planus skin rash develop white streaks on the inside of the cheeks, gums or tongue. This is usually painless and not itchy. It may not be noticed unless looked for. Sometimes lichen planus of the mouth occurs without any skin rash.

Lichen planus can also cause ulcers in your mouth but this is uncommon. If they occur they can be very sore and unpleasant. Hot or spicy foods are especially difficult to eat.

Mouth ulcers can occur with or without the skin rash. In some cases, the gums become red and sore.

Lichen planus of other parts of the body

Most people with lichen planus just have the skin rash and/or mouth involvement. However, in some cases other areas of the body are also affected. These include the following:

• Vulva and vagina of women - lichen planus can cause painless white streaks on the vulva. However, it can also cause painful red sore areas of the vulva and entrance to the vagina. This can be sore, itchy and in severe cases make it very painful to have sex. Scar tissue may also develop which may narrow the entrance to the vagina.
• Penis of men - the typical skin rash may affect the head of the penis (glans). Also, white patches may develop on the glans.
• Nails - about 1 in 10 people with lichen planus have affected nails. It usually causes minor ridging of the nail. Rarely, severe damage to the nail can occur.
• The scalp - which can cause patches of baldness.
• Rarely - the gullet (oesophagus), eyelids, ear canal, bladder and back passage (anus) are affected. This may be seen with erosive lichen planus.