Lichen planus

8.4.2012 , Jiří Dyntr

lichen-planus.jpg - kopie
lichen-planus.jpg - kopie
Lichen planus je kožní onemocnění dosud neobjasněného původu, vyskytující se souměrně na různých částech těla. Lichen planus je charakteristický červenohnědými lesklými skvrnami nepravidelného tvaru. Ačkoliv se nejedná o nijak nebezpečné onemocnění, některé pacienty může provázet celý život, jelikož zatím neexistuje žádný konkrétní lék, který by dokázal lichen planus úplně vyléčit.

Lichen planus

Lichen planus je poměrně obvyklé onemocnění kůže, jehož příčina není dosud přesně známá. Odborníkům se však podařilo zjistit, že v jeho průběhu probíhají obdobné děje, jako když imunitní systém příjemce odmítá transplantovaný orgán od dárce. Tedy že jde o autoimunitní reakci organismu, kdy vytváří látky proti vlastním buňkám těla, protože je pokládá za buňky cizí. Lichen planus se může vyskytovat v mnoha různých formách a jeho projevy jsou často velmi různorodé. Rozlišení od dalších, podobně se projevujících chorob kůže je proto poměrně obtížné.

Příčiny vzniku lichen planus

Příčina vzniku onemocnění zvaného lichen planus není dosud přesně známá. Jisté však je jedno a to, že toto onemocnění není nijak nakažlivé a není způsobeno žádným mikroorganismem. Byl však vypozorován jeho zvýšený výskyt při různých jiných onemocněních nebo při používání některých léčiv. Častěji se lichen planus objevuje jako součást alergické reakce při nesnášenlivosti některých léků. Mezi taková léčiva patří například léky na vysoký krevní tlak nebo na některé srdeční a cévní choroby. Dále je lichen planus považován za jednu z komplikací onemocnění jater, například při virové hepatitidě typu C. Lichen planus může též vzniknout jako doprovodný příznak při transplantaci, když tělo odmítá nevhodně zvolený transplantovaný orgán. V tomto případě dochází tedy k autoimunitní reakci.

Příznaky lichen planus

Lichen planus vytváří na kůži červenohnědé lesklé skvrny, které mají nepravidelný tvar. Tyto skvrny jsou obvykle lokalizovány souměrně na obou polovinách těla a typická je pro ně tendence ke splývání do větších výraznějších celků. Nejčastěji se kožní změny lichenu vyskytují na dlaňových stranách zápěstí, v křížové krajině a na nártech, kde také po jejich zhojení přetrvávají typická šedohnědá ložiska. Kromě klasických projevů může lichen planus vytvářet celou řadu dalších kožních změn a podle toho se dělí do mnoha skupin. V některých případech tak lichen planus postihuje především kůži trupu, genitálu nebo plosek nohou a dlaní. Jindy ale dochází také k poškození sliznice dutiny ústní a jejího okolí nebo také sliznici konečníku. Výjimkou není ani deformace nebo úplná ztráta nehtů či tvorba bolestivých prasklin na kůži s následným výrazným jizvením. Při mikroskopickém vyšetření kůže napadené touto chorobou, je dobře zřetelné výrazné přemnožení kožních buněk a také přítomnost vyššího počtu bílých krvinek.

Lichen planus a jeho komplikace

Po zlepšení až vymizení kožních projevů lichen planus, mohou na kůži zůstat tmavé skvrny. Ty jsou hnědě či šedě zbarvené. Nepůsobí žádné zdravotní problémy, spíše obtíže psychického rázu. Komplikace, kterými jsou kožní projevy, však ve většině případů samy zmizí. Pokud ne, lze tyto příznaky alespoň částečně zmírnit používáním speciálních hojivých mastí.Ve vzácných případech, kdy přetrvávají v dutině ústní vředy, může dojít až ke zvýšení rizika pro vznik rakoviny.

Léčba lichen planus

Účinná léčba onemocnění lichen planus, která by působila cíleně přímo proti jemu, v současné době bohužel neexistuje. Přesto se pomocí některých protizánětlivých přípravků daří projevy onemocnění tlumit a někdy dokonce dosáhnout tzv. spícího stavu, ve kterém onemocnění setrvává ve stejném stádiu určitou dobu a dále se nezhoršuje. Bez léčby je průběh onemocnění těžce odhadnutelný. V některých případech zcela odezní a už se znovu neobjeví, jindy se v různě dlouhých intervalech navrací v průběhu celého života pacienta. Obvykle přetrvává i několik let bez větších následků, ale může také způsobit rozsáhlé zjizvení sliznic i kůže, ztrátu vlasů a deformace nehtů, což pacientovi působí velké nepříjemnosti i po psychické stránce.

Prevence lichen planus

Prevence lichen planus je velmi obtížná a vzhledem k neznámým vyvolávajícím příčinám i špatně proveditelná. Prevence tohoto onemocnění zahrnuje zejména prevenci vzniku lichenoidních skvrn. Snažíme se proto nevysazovat předepsané léky, či naopak neužívat zbytečně léky, které mohou tyto kožní problémy způsobovat. V případě orální formy je vhodné léčit onemocnění ve spolupráci s vaším zubařem.

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24. srpna 2016 2:57

Alena: Dobry den, mam lichen na rodidlech a dostala jsem mast Dermovate.Bojim se pouzit kortikoidy.Neni neco jineho bez kortikoidu ? Dekuji A.S.

8. října 2015 14:43

Elena: Lichen se u mě objevuje posledních 10 let s přestávkami. Při malém výskytu mažu Elocom, pokud je toho víc nezbývá než obvyklé zaléčení: injekce Diprophos, pravidelné ozařování SUP a místně Elocom nebo Belosalic.

25. března 2015 17:06

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