Varicolored (papillary) lichen planus

Pityriasis versicolor (synonym: pityriasis versicolor) is a low-contagious chronic disease of people, mainly young and middle-aged, characterized by damage to the stratum corneum of the epidermis and a very weakly expressed inflammatory reaction and caused by the lipophilic yeast-like fungus Pityrosporum cibiculare.

Causes of pityriasis versicolor

The causative agent of the disease is Mallasseria furfur. Versicolor lichen occurs as a result of the transformation of the saprophylactic form into a pathogenic one or external infection. The development of versicolor lichen is facilitated by a weakened immune system, increased sweating, and endocrine disorders. The development of the disease is facilitated by a change in the physicochemical properties of the water-lipid mantle of the skin and the keratin of the stratum corneum. They can be caused by increased sweating, seborrhea, and some endocrine disorders (Itsenko-Cushing syndrome, diabetes mellitus, obesity, hyperthyroidism, etc.). The disease occurs in all geographic zones, but more often in regions with a hot climate and high humidity.

It has been established that the lipoxygenase of the pathogen oxidizes unsaturated fatty acids of sebum into dicarboxylic acids. As a result, inhibition of melanocyte tyrosinase and a decrease in melanin synthesis in the lesion occur. The disease is often found in HIV-infected patients.

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Symptoms of pityriasis versicolor

Both men and women suffer from versicolor lichen.

The rash is often localized on the chest, back, armpits; from here the rash spreads to the shoulders, sides of the body, stomach. The disease versicolor lichen begins with the appearance of pinkish, quickly acquiring a brown color, flaky spots.

As a result of peripheral growth, the initial elements turn into round, sharply defined spots up to 1 cm in diameter. The spots can merge and form large foci occupying the entire back, trunk and chest. The elements have scalloped outlines, with isolated spots scattered along their periphery. The color of the rash varies widely from pale cream to dark brown. The surface of the rash is covered with bran-like scales formed as a result of the fungus loosening the horny layer of the epidermis. With frequent washing, the scales are barely noticeable, but scraping easily causes a floury peeling (Besnier's symptom). There are forms similar to erythrasma, urticaria, resembling vitiligo. Subjective sensations are usually absent.

After artificial ultraviolet irradiation, white pseudochromic spots remain in the area of the rash. The course of the disease is long and can last for many years.

Diagnosis of versicolor lichen

The diagnosis of "pityriasis versicolor" is established on the basis of a characteristic clinical picture and laboratory test data. To confirm the diagnosis, the Balzer test is used: the lesions and adjacent areas of healthy skin are smeared with a 5% iodine tincture (at a lower concentration, the test may be questionable) - the rash, due to the loosened stratum corneum, is colored more intensely than the healthy skin surrounding it. During fluorescent examination with a Wood's lamp, a yellow glow is observed in the lesions. In the rays of a fluorescent lamp, the lesions glow golden-yellow. The morphology of the pathogen is very characteristic during a microscopic examination of scales from the lesions (short, wide, curved pseudomycelium and single or clustered large spores).

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Differential diagnosis

In the presence of hypopigmented spots, the disease pityriasis versicolor should be distinguished from vitiligo, white lichen, syphilitic leukoderma. The flaky spot is differentiated from guttate psoriasis, pink lichen, seborrheic dermatitis,

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Treatment of versicolor lichen

Keratolytic and fungicidal agents are widely used. For limited rashes, 5% salicylic alcohol, sulfur-(3%)-salicylic (5%) ointments are used 2 times a day for 5-7 days, the Dem'yanovich method (6% hydrochloric acid solution and 60% sodium thiosulfate solution are rubbed in successively). Antifungal ointments are prescribed - zalain, clotrimazole, nizoral, etc.

Rubbing is done twice a day. In widespread and torpid cases, oral administration of systemic antifungal agents is indicated - intraconazole (teknazole, orgunal, etc.) at a dose of 200 mg per day for 7 days. Currently, in the treatment of versicolor lichen, lamisil spray is most often used from local antifungal agents, since it can be used to treat large and hard-to-reach areas of the skin.

Prevention of versicolor lichen consists of disinfecting underwear and bed linen and correcting sweating.