Optimization of therapy in patients with lichen ruber planus by means of cranial electrotherapy stimulation

Rationale: Taking into account the significance of psychogenic factor in the onset of lichen planus, its correction is advisable. Transcranial electric stimulation is promising, given its autonomous regulating, analgesic, antipruritic, reparative and regenerative, and immunomodulatory effects, in addition to the anti-stress one.Aim: To assess the effectiveness of the combination therapy including cranial electrotherapy stimulation (CES) with lichen ruber planus.Materials and methods: This was an open label, prospective, comparative study in 61 patients with common typical form of lichen ruber planus (39 (63%) women and 22 (37%) men) aged 18 to 74 years (mean age 41 ± 14.29 years). The duration of the disease was 11.88 ± 10.15 months (range, 1 to 42 months). The patients were adaptively randomized into two groups of similar gender distribution, age, and disease duration. The patients in the comparison group (n = 30) were treated conventionally in accordance with the Federal Clinical Guidelines (chloroquine, hydroxyzine, topical corticosteroids). The main group (n = 31) was administered similar therapy; however, instead of hydroxyzine, CES was performed. The duration of in-patient treatment in both groups was 14 days, with the follow-up lasting for up to 3 months. The results of treatment were assessed by dynamics of pathological changes of the skin (Index of Lichen Planus, ILP), impact of dermatosis on various domains of the patient’s life (Dermatology Life Quality Index, DLQI), changes in psychological status (Hamilton Anxiety Scale and Hamilton Depression Scale). In addition, the impact of pruritus on the patients' daily activities was assessed by Behavioral Rating Scores questionnaire (BRS).Results: At baseline, there were no significant differences between the groups in ILP (p = 0.801), DLQI (p = 0.501), BRS (p = 0.521), Hamilton Anxiety Scale (p = 0.301), and Hamilton Depression Scale (p = 0.493). At the end of treatment, ILP in the CES group decreased 3.25-fold (p < 0.001), whereas in the group treated with conventional therapy the decrease was 2.1-fold (p < 0.001); DLQI decreased 2.5-fold (p < 0.001) and 1.8-fold (p < 0.001), respectively. The corresponding decreases of Hamilton Anxiety Scale in the treatment groups were 2.3-fold and 1.3-fold, respectively, and those in Hamilton Depression Scale – 2-fold and 1.6-fold, respectively (all p < 0.001). In addition, statistically significant intergroup differences were found for ILP (p = 0.04), DQLI (p < 0.001), Hamilton Anxiety and Depression scale scores (p = 0.021 and p = 0.006, respectively). As for the BRS changes, in both groups there was an equally significant (p < 0.001) decrease, but the intergroup differences were not statistically significant (p = 0.485).Conclusion: The proposed combination therapy of patients with lichen ruber planus including CES has led to a decrease in the indicators of the skin process activity within a shorter time period than in the patients under conventional treatment. In addition, the patients of both groups showed normalization of psychological parameters and improvement in dermatological quality of life; however, only in the CES group, these changes were significant.

New therapeutic strategies of lichen ruber planus

Lichen ruber planus/lichen planus (LP), is a chronic immune-mediated inflammatory disease that affects the skin, oral mucosa, genital mucosa, scalp and nails. Planar, purple, polygonal, pruritic, papules and plaques appear on the flexor surfaces of the wrists, forearms and legs. Mucosal lesions are often lacy, reticular, white lines known as Wickham striae. Topical corticosteroids are the first-line therapy for all forms of LP, for severe, widespread LP systemic corticosteroids, acitretine, oral immunosuppressants or narrowband UVB therapy should be considered. Cutaneous LP may resolve spontaneously within one or two years, while mucosal LP may be more persistent and resistant to treatment.

Clinical analysis of cases of lichen ruber planus in the oral cavity

The manifestation of skin diseases in the oral cavity can be detected by doctors of any profile during the interview and examination of the patient. Often, the diagnosis is carried out by a dentist. A thorough diagnostic search allows you to determine the main clinical manifestations and treatment tactics. The dentist independently prescribes local therapy. A complex general effect is recommended by a dermatologist. Severe cases require inpatient treatment. A correct diagnosis and adequate medical measures improve the general condition and the local clinical picture, as well as contribute to a stable remission of the disease.

ACUPUNCTURE IN TREATMENT OF РАTIENTS WITH CRONIC DERMATOSES

The article is devoted to reflexotherapy of patients with different dermatoses. The experience of treatment with acupuncture of chronic skin diseases in reflexotherapy room is analised. The selection of acupuncture meridians and points in dermatological patients is proposed. The results of acupuncture of patients with lichen ruber planus, atopic dermatitis, eczema, chronic urticaria, prurigo, psoriasis of palms and soles, lichen ruber pillaris Devergy are discussed. Effect of therapy on basis of psychosomatic nature is explained.

Lichenoid vulvar dermatoses: clinical presentation, morphology, and dermatoscopic signs

Lichenoid vulvar dermatoses are a heterogeneous group of diseases characterized by a number of overlapping signs and/or morphological features. Clinical similarity is accounted for by the appearance of small discrete papules with closely adjacent superficial squamae. The prototype of lichenoid dermatoses is lichen ruber planus. Histologically, lichenoid pattern is characterized by basal epithelial cell damage and a band-like infiltrate in the upper dermis. The International Society on Vulvovaginal Diseases categorizes lichen ruber planus and early lichen sclerosus as dermatoses with this histological pattern. Some authors also classify plasma cell (Zoon) vulvitis as lichenoid vulvar dermatoses. The cause of diagnostic errors lies in the similarity of the clinical and histological presentations of lichenoid vulvar dermatoses. Dermatoscopy should be considered as an additional diagnostic test. Only few studies address the key dermatoscopic signs of vulvar dermatoses. Histological study is important for the differential diagnosis. However, at some stages of disease evolution, vulvar dermatoses can have an overlapping histological pattern. This paper summarizes the data on the clinical, histological, and dermatoscopic presentation of the most common lichenoid vulvar dermatoses, i.e., lichen planus, lichen sclerosus, lichen simplex chronicus, and plasma cell vulvitis. KEYWORDS: lichenoid dermatoses, vulvar dermatoses, lichen sclerosus, lichen planus, lichen simplex chronicus, plasma cell vulvitis, Zoon vulvitis, dermoscopy. FOR CITATION: Parygina O.V., Smirnova I.O., Oganesyan M.V. et al. Lichenoid vulvar dermatoses: clinical presentation, morphology, and dermatoscopic signs. Russian Medical Inquiry. 2020;4(10):617–624. DOI: 10.32364/2587-6821-2020-4-10-617-624.

Annular lichen planus, a rare variant of lichen planus

The paper reviews current data on lichen ruber planus, a disease characterized by multifactorial pathogenesis, polymorphic clinical symptoms, severe long recurrent course, and a significant resistance to treatment. In the last decades, a substantial growth in the prevalence of this dermatosis is observed. Moreover, the rate of atypical cases also increases. The most common symptoms at disease onset are a generalized rash, severe itching, and malaise. Many patients present with acute clinical signs. Patients with the different forms of the disease (in particular, those with oral lichen planus) report on the significant reduction in the quality of life. The authors describe the specificity of clinical polymorphism, the variability of clinical manifestations and HLA system in annular lichen planus. The aim of this paper is to summarize currently available data considering the diversity of clinical variants which are required for the understanding of the pathogenesis to improve the diagnosis in difficult cases and to control its course. The authors also address a case study of annular lichen planus in a 63-year-old woman. KEYWORDS: lichen ruber planus, dermatosis, histopathology, HLA system. FOR CITATION: Zakhur I.I., Koshkin S.V., Bobro V.A. Annular lichen planus, a rare variant of lichen planus. Russian Medical Inquiry. 2020;4(10):642–646. DOI: 10.32364/2587-6821-2020-4-10-642-646.

The state of prooxidant-antioxidant homeostasis and immune status in patients with lichen planus and its correction

Objective - increasihg the effectiveness of treatment for patients with lichen planus by developing an improved tactic of complex differential therapy, taking into account changes in the parameters of prooxidant-antioxidant homeostasis, immune status of the organism and clinical manifestations of dermatosis. Material and methods. Under the supervision were 124 patients with lichen planus (85 women, 39 men) aged 24 to 67 years. In patients with lichen planus, the parameters of prooxidant-antioxidant homeostasis and immune status were determined before and after standard treatment (I comparative group - 42 patients), standard treatment with the inclusion of quercetin preparation (II comparative group - 41 patients) and the developed complex treatment using quercetin, polyenzyme preparation and low-intensity laser therapy with antioxidant and anti-inflammatory effects (III - main group - 41 patients) by known methods. Results. The modern tendencies of morbidity and clinical features of the course of lichen ruber planus have been investigated. A significant increase in patients with lichen ruber planus activity of the processes of free radical oxidation of lipid and protein structures with the formation of oxidative stress and the state of endogenous intoxication were established. Changes in phagocytosis, increase in serum levels of circulating immune complexes and certain proinflammatory cytokines were defined in patients with lichen ruber planus, their dependence on the nature of the clinical course of dermatosis was determined. An improved method of complex treatment of lichen ruber planus with the use of quercetin, a polyenzyme medication and low-intensity laser therapy with antioxidant and anti­inflammatory action has been developed. Conclusions. The developed advanced complex treatment of lichen planus patients with combined and differentiated use and the background of standard therapy for quercetin, a polyenzyme preparation, and low-intensity laser therapy with antioxidant and anti-inflammatory effects contributes to the normalization of prooxidant-antioxidant homeostasis, phagocytosis, circulating immune complexes of cytosets and studied pro-inflammatory direction, and also likely to improve short- and long-term clinical outcomes of therapy for such patients.