Lichen? What you need to know.

Lichen? What you need to know.

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Lichen

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Lichen is a group of skin diseases with various causes, which are characterized by an appearance of rash-like, itchy characteristics.  There are several varieties of the disease, which differ by the type of the agent, lesions, localization, level of contagiousness (eczema – weeping dermatitis; microsporia, fagus, trichophytosis – ringworm, psoriasis, pink zoster – pityriasis; herpes zoster). The course of the disease is long, with exacerbations and a risk of secondary infection of the skin rash.  It brings physical and psychological discomfort to the patient, as well as cosmetic defects.

Lichen is a kind of skin condition characterized by the appearance of colored blots. Etiology, ways of infection and specifics of the disease course may be different, as these conditions are grouped according to their clinical manifestations – the color change, peeling or flaking either of skin or pustules.

Cause & Infection

The main causes are viral and fungal microflora. The mechanism of the infection is unknown, as not all people, even those from the risk group, might get lichen. The combination of factors such as low immunity, stress, genetic predisposition, infectious diseases, physical and emotional stress, presumably increases the likelihood of getting lichen.

RingwormDepending on the age and gender group, the incidence of various types of lichen can be varied, but the general data is roughly the same. The duration and nature of the lichen disease course also vary from acute to chronic.

Pink zoster

The disease has both the infectious and allergic nature, is found among all age groups all over the world, and is characterized by the appearance of round scaly pink patches on the skin of the body, in most cases on the skin of the back.

Pink zoster is not a highly contagious disease and it’s flares inside the same family are  seldom recorded. Infection can be transferred through the use of a common bath accessories. Among the causal factors are the decrease in immunity and viral respiratory infections. Pink lichen is characterized by seasonal appearance, with the disease incidents being recorded in spring and fall. The absence of relapses of the pink lichen gives reason to believe in the development of a strong immunity to the disease.

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Onset of the disease is characterized by the appearance of a single source rounded spot no bigger than 3 cm in diameter, the central part of which becomes yellow in 2-3 days, wrinkles and begins to peel.  In 7-10 days a lot of similar but much smaller patches appear on the skin of the back and chest. The pink zoster rash is localized mostly along the lines of Langer (lines of maximum skin stretching). Over time, the center of the patch starts peeling, and a red border appers around it. These patches do not tend to merge. Itching and other unpleasant sensations are absent.

Pink zosterInadequate therapy, frequent contact with water and sweating increases the duration of the disease, although the pink zoster fully cures in 1.5-2 months. Pink zoster often resolves on its own without any treatment. Patients are advised to not stay in the sun, do not wear synthetic clothes and limit contact with water. The use of antibacterial and antifungal ointments such as Sanguiritrinum quickly eliminate the pink zoster symptoms. Antibacterial solutions including those made of herbs, have positive effect. These measures are often sufficient to cure the pink zoster.

Pink zoster is diagnosed based on the medical examination and requires differentiation from the roseola typical for syphilis.

Herpes zoster

Herpes zoster has the herpes-related nature and occurs in case of the secondary contact with the virus from the Herpes zoster group, or in case of activation of the latent herpes infection. Herpes zoster means an inflammation of the nerve ganglia, when the characteristic rash appears along the nerve trunks. It mostly affects adults and the elderly people, and is provoked by stressful situations, infection, and decreased immunity. The course of herpes zoster disease can vary, from mild to severe, affecting even the central nervous system. Before the rash emerges, the ill person can feel tenderness along the nerves, and in 3-4 days the disease  signes appear on the skin. In case of herpes zoster, the surface of the shingles rash initially consists of small vesicles, which then shrivel into the crust, sometimes  peeling can be registered. Depending on the severity of the herpes zoster, only minor symptoms of intoxication or meningeal signs can be found. In complicated forms of the disease  prognosis is extremely unfavorable.

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Herpes zosterTypical clinical signs allow to make accurate diagnosis based on a visual examination and interviews with the patient. The treatment regimen for herpes zoster depends on the severity of the clinical manifestations and of the patient’s condition. Almost in all cases it requires hospitalization. Treatment is carried out both by a dermatologist and a neurologist together. If the patient experiences strong pain,  analgesics and sedatives are prescribed, in case of any brain disturbance, the doctor prescribes the drugs to correct the work of the CNS. The use of antivirals and immunomodulators is indicated for all patients with herpes zoster. Local treatment is limited to the use of antiviral ointments and prevention of bacterial complications. The prognosis depends on the severity of the disease course and the suitability of the prescribed therapy.

Scaly skin disease

Scaly skin disease or pityriasis versicolor is a fungal disease that affects the corneous (horn-like) layer of the epidermis.  Sweating, hot climate, seborrheic skin condition are the predisposing factors for the occurrence of scaly skin disease.  The incidence of pityriasis versicolor is higher among women and young people. Flares of infection and recurrence of the scaly skin disease are reported during the hot season.

Infection is transfer red through the household contact  by use of shared combs, household items, as well as by direct contact with an ill person.

The scaly skin disease begins with the emergence of a single circular pink patch, then the same spots of smaller diameter appear on the smooth skin and scalp. The pityriasis versicolor skin changes have a non-inflammatory nature, the patches are usually yellowish-brown, with slight signes of exfoliation if scraped. Patches of the pityriasis versicolor are prone to peripheral growth and merging, the do not cause any itching or other subjective feelings. Under the influence of ultraviolet radiation, secondary leucoderma is found on the skin lesions.

The scaly skin disease is diagnosed by a careful visual examination, as sometimes it might go unnoticed due to the insignificance of symptoms and lack of any discomfort. Microscopy evaluation of the scraping sample reveals a characteristic accumulation of mycelium and fungus threads. Treatment contains use of tablets and ointments with antifungal drugs. Treatment of affected areas with salicylic alcohol before applying ointments allows the active substance to penetrate deeper into the layers of the skin. Following the rules of personal hygiene is the only prevention measure against the pityriasis versicolor. It is impossible to get rid of the mycotic cells completely, that’s why in spring people who have had this condition should use cosmetics with anti-fungal effect and avoid sun exposure to prevent a recurrence of the disease.

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Ringworm

Ringworm or trichophytosis is a fungal skin disease that affects smooth skin, scalp and even nails. The source of infection is the sick people and animals, infection occurs through the household contact. Ringworm flares inside the family and in a kindergarten environment are the most frequent.

Lichen causesAfter germination by mycelium the hair structure breaks, and they come off, leaving behind a “hemp”. As the ringworm condition is characterized by appearance of red rings of rash having clear skin in the middle it was named the ringworm.  There is a slight peeling and a light cover of the fungi spores on the affected skin. Itching and discomfort are absent. Ringworm can be almost asymptomatic, but on closer inspection the “hemp” hair might be noticed. Suppurative forms of the ringworm are characterized by a dense purulent infiltrate from which the pus comes if pressure is applied. The infiltrates can be of different sizes, but usually appear on the scalp, in the beard and mustache area. The infiltrate might either safely cure on inself in 7-10 days because of the destructive effect of the pus on the mycotic cells or turn into a complicated abscess. If untreated, the mycotic cells would remain on the periphery and maintain a chronic slow course  of the ringworm disease.

Diagnosis is based on clinical manifestations. Microscopy testing of the scraping samples confirms the nature of the mycotic disease, and the discharge inoculation reveals the type and form of the pathogen and allows to determine its sensitivity to antifungal drugs.

Ringworm treatment consists of the local application of antifungal ointments and internal use of tablet forms. Complicated forms of the ringworm require therapy of the symptoms. Ringworm prophylaxis includes adhering to the rules of personal hygiene, early identification of the infected persons and regular medical inspection of children in the childcare centres.