Pink lichen: causes, symptoms, diagnosis, treatment

Pink lichen (synonyms: Titra disease, roseola scaly) is an infectious-allergic skin disease, a severe dermatosis characterized by spotty rashes.

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Causes of Pityriasis Rosea

The most recognized is the infectious theory, since the disease most often develops after a cold, acute respiratory viral infection, and a positive intradermal reaction with a streptococcal vaccine is noted. Stress reactions, pregnancy, and atopy can provoke the development of the disease. The disease may be caused by a viral infection.

Pathomorphology of pityriasis rosea

In fresh elements, the histological picture resembles an eczematous reaction. Edema of the papillary dermis, perivascular inflammatory infiltrates of lymphocytes with an admixture of neutrophilic and eosinophilic granulocytes are noted. In the formed foci, slight acanthosis, spongiosis in places and focal parakeratosis are found. In 50% of cases, migration of lymphocytes into the epidermis with the formation of vesicles in its upper part is observed. If the vesicle is filled with exudate cells, it looks like a microabscess. A similar picture may resemble contact dermatitis. In later stages, focal parakeratosis is combined with acanthosis and elongation of epidermal growths, which may resemble psoriasis, but the presence of vesicles in the epidermis and significant intercellular edema distinguish pink lichen from psoriasis. In the final stage of the disease, the histological picture resembles that of plaque parapsoriasis.

Histogenesis has been poorly studied. Based on immunophenotyping of cellular infiltrates, it has been suggested that the inflammatory response is associated with activated T lymphocytes and dendritic cells.

Symptoms of pityriasis rosea

Pink lichen is a common dermatosis and occurs mainly in people aged 20-40. Outbreaks of the disease are usually observed in spring and autumn. Clinically, it is characterized by development against the background of mild general reactions in the form of malaise, cold symptoms. The dermatosis often begins with the appearance of a "mother plaque" or "mother spot", which is characterized by large sizes (about 2-3 cm or more) and a bright pink color. At the same time, the central part is slightly sunken, its surface has the appearance of wrinkled tissue paper, a yellowish tint, covered with small scales. Along the periphery of the spots, their original pink color is preserved, which makes the spot look like a medallion. Usually, a few days after the appearance of the mother spot, disseminated, multiple, sometimes scattered over the entire skin, oval or round pink or pink-red spots with a diameter of 0.5-1 cm, not prone to merging, appear. Then, on average, after 6-7 days, multiple smaller spots appear, similar in morphology to the mother plaque, located mainly on the body parallel to Langer's lines. Sometimes the palms and soles are affected, as well as the mucous membrane of the oral cavity. Rare variants are urticarial, vesicular, papular, miliary, follicular. Giant spots (pityriasis circinata et marginata Vidal) may be observed. After 1-2 months, the process resolves. With irrational (irritating) treatment, regression occurs much later.

During the period of rash of fresh elements, sometimes there is a slight malaise and a slight increase in body temperature, enlargement of the cervical and submandibular lymph nodes. Pink lichen proceeds cyclically, i.e. in the first 2-3 weeks of its existence, several outbreaks of new rashes are noted.

At the site of the resolved rash, hyper- or depigmented spots may remain, which then disappear without a trace. Subjective sensations are absent in most cases. Relapses of the disease are usually not observed. After recovery, a fairly stable immunity remains.

Differential diagnosis

The disease pink lichen should be distinguished from psoriasis, seborrheic eczema, secondary syphilis, and superficial trichophytosis.

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Treatment of pink lichen

It is necessary to follow a hypoallergenic diet (exclude irritating foods from the diet: alcohol, smoked foods, salted and pickled foods, coffee, chocolate, strong tea, etc.), limit water procedures. In case of uncomplicated pink lichen, according to a number of dermatologists, active treatment of pink lichen is not carried out. In case of exacerbation and widespread forms, broad-spectrum antibiotics, vitamins (A, C, PP, group B) and antihistamines are prescribed. Locally, water and oil shaken suspensions, corticosteroid ointments or creams are recommended.