CLINICAL REPORT
505 Advances in dermatology and venereology ActaDV Acta Dermato-Venereologica ActaDV
Clinical Aspects of Itch in Lichen Planus
Kalina WELZ-KUBIAK, Adam REICH and Jacek C. SZEPIETOWSKI Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
Lichen planus( LP) skin lesions are often accompanied by itch, but this symptom has not been thoroughly examined in LP. To better characterize itch in LP, 78 patients with LP were investigated. Itch was present in 94.9 % of patients and was usually described as the most vexing symptom of LP. The mean ± SD severity of itch according to visual analogue scale score was 6.9 ± 2.8 points. Most patients experienced itching daily, pruritus episodes lasted longer than 1 min, and most often occurred in the evening. Itch was frequently described as burning and, for many patients, it was considered burdensome and annoying. The following factors most often increased the perceived severity of pruritus: sweating, high temperature, stress and hot water, while cold water and cold air often resulted in itch reduction. In conclusion, itch is the major subjective symptom of LP. Effective treatment of pruritus should be one of the main goals of LP therapy.
Key words: chronic dermatoses; pruritus; clinical characteristics. Accepted Nov 8, 2016; Epub ahead of print Nov 9, 2016 Acta Derm Venereol 2017; 97: 505 – 508.
Corr: Adam Reich, Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Ul. Chalubinskiego 1, PL-50-368 Wroclaw, Poland. E-mail: adi _ medicalis @ go2. pl
Lichen planus( LP) is a chronic, papulo-squamous disorder of the skin, mucous membranes, nails and hair, with significant variability in its severity and evolution. LP is a rather uncommon condition, affecting approximately 0.5 % of the general population in Europe, with a similar incidence in males and females( 1). The typical clinical manifestations of LP on the skin include the presence of polygonal, flat-topped, violaceous papules and plaques with reticulated white lines, termed“ Wickham’ s striae”; however, a number of different clinical variants have also been described( 2). LP lesions may appear as an isomorphic response to minor trauma( Koebner phenomenon). The disease most commonly affects the extremities, especially the flexures, such as the wrists and ankles. Involvement of mucous membranes is present in approximately 30 – 70 % of patients with LP( 2). Oral LP most commonly appears as asymptomatic or tender, white, reticulated patches or plaques( reticulated form), or as painful erosions and ulcers( erosive form). LP of the genitalia most commonly presents with pruritus or hyperalgesia, in particular in the erosive variant, and may lead to vaginal discharge or erosive forms of haemorrhage( 2).
Itch is a cardinal subjective symptom of cutaneous lesions of LP. In our preliminary study we have shown that itch is the most unpleasant and bothersome symptom for the majority of patients with LP( 3, 4). This is in accordance with other previously published studies, which have demonstrated that itch can greatly alter the well-being of patients with different conditions, and that subjects with chronic pruritus may have significantly impaired quality of life, and depression and anxiety( 5 – 8). Despite its importance, clinical aspects of itch in LP have not been well characterized in the literature. The aim of this study is therefore to better describe the clinical manifestation of itch in LP, in order to increase understanding of this symptom, and help enable the development of effective antipruritic treatment strategies to improve medical care for such patients.
MATERIALS AND METHODS Patient characteristics
A total of 78 consecutive adult patients with LP, diagnosed based on typical clinical presentation and histology, and treated between 2012 and 2015 at the Department of Dermatology, Venereology and Allergology of the Wroclaw Medical University, Wroclaw, Poland were enrolled in the study. Patients with other dermatological conditions that could have influenced the results were not included. There were 52( 66.7 %) females and 26( 33.3 %) males( ratio 2:1), age range 17 – 91 years( mean age 53.0 ± 14.0 years). Detailed characteristics of included patients are shown in Table I; there were no patients with the predominant erosive variant in this series. Patients with LP received potent topical corticosteroids combined with phototherapy( narrow-band ultraviolet B( UVB) 311 nm or psoralen plus ultraviolet A( PUVA)) as first-line treat-
Table I. Demographic and clinical characteristics of enrolled patients with lichen planus( LP)
Patient characteristics
Sex, n(%) Women
52( 66.7)
Men 26( 33.3)
Age, years, mean ± SD 53.0 ± 14.0
Range, years 17 – 91
Disease duration, years, mean ± SD 3.9 ± 7.7
Range, years 0.1 – 37.0
Duration of the current exacerbation, months, mean ± SD 5.7 ± 7.0
Range, months 0.5 – 48.0
Clinical subtype of LP, n(%) Classic papular LP( eruptive)
47( 60.3)
Classic papular LP( localized) 22( 28.2)
LP pigmentosus 4( 5.1)
Hypertrophic LP 3( 3.8)
Vesiculobullous LP
2( 2.6) Mucous membrane involvement, n(%) 38( 48.7)
SD: standard deviation.
This is an open access article under the CC BY-NC license. www. medicaljournals. se / acta Journal Compilation © 2017 Acta Dermato-Venereologica. doi: 10.2340 / 00015555-2563 Acta Derm Venereol 2017; 97: 505 – 508