tailieunhanh - Clinical Dermatology - part 3

Tổn thương cá nhân có thể kéo dài nhiều tháng và các vụ phun trào như một toàn thể có xu hướng kéo dài khoảng 1 năm. Tuy nhiên, biến thể phì đại của bệnh, với nốt sần nhỏ dày tổn thương thường là xung quanh mắt cá chân | 66 CHAPTER 6 fine longitudinal grooves to destruction of the entire nail fold and bed see Fig. . Scalp lesions can cause a patchy scarring alopecia. Course Individual lesions may last for many months and the eruption as a whole tends to last about 1 year. However the hypertrophic variant of the disease with thick warty lesions usually around the ankles Fig. often lasts for many years. As lesions resolve they become darker flatter and leave discrete brown or grey macules. About one in six patients will have a recurrence. Complications Nail and hair loss can be permanent. The ulcerative form of lichen planus in the mouth may lead to squamous cell carcinoma. Ulceration usually over bony prominences may be disabling especially if it is on the soles. Any association with liver disease is probably caused by the coexisting hepatitis infections mentioned above. Differential diagnosis Lichen planus should be differentiated from the other papulosquamous diseases listed in Table . Lichenoid drug reactions can mimic lichen planus closely. Gold and other heavy metals have often been implicated. Other drug causes include antimalarials p blockers non-steroidal anti-inflammatory drugs para-aminobenzoic acid thiazide diuretics and peni cillamine. Contact with chemicals used to develop colour film can also produce similar lesions. It may be hard to tell lichen planus from generalized discoid lupus erythematosus if only a few large lesions are present or if the eruption is on the palms soles or scalp. Wickham s striae or oral lesions favour the diagnosis of lichen planus. Oral candidiasis p. 000 can also cause confusion. Investigations The diagnosis is usually obvious clinically. The histology is characteristic Fig. so a biopsy will confirm the diagnosis if necessary. Treatment Treatment can be difficult. If drugs are suspected as the cause they should be stopped and unrelated ones substituted. Potent topical steroids will sometimes relieve symptoms and flatten the .

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