Do najczęstszych objawów liszaja twardzinowego zalicza się przewlekły stan zapalny skóry, któremu towarzyszą porcelanowobiałe zmiany o charakterze grudkowym, które najczęściej zlewają się w większe, lekko twarde ogniska bądź nadmierne rogowacenie ujść mieszków włosowych, zwane hiperkeratozą mieszkową.
Schorzenie to może dotyczyć zarówno mężczyzn, jak również kobiet, które najczęściej zapadają na nie w tzw. dwóch szczytach zachorowań, tzn. przed okresem dojrzewania lub w 5. – 6. dekadzie życia.
Początkowo choroba ujawnia się pod postacią pojedynczej plamy na skórze bądź wielu, ale mniejszych rozsianych plam o nieregularnych kształtach. Najczęstszym miejscem wykwitu jest skóra w okolicy boków szyi, obojczyka, ramion, przestrzeni między i pod piersiami, a także w zgięciach dłoni. W bardzo rzadkich sytuacjach zmiany skórne mogą objąć błonę śluzową jamy ustnej. Wówczas najczęściej lokalizują się na policzkach oraz pod językiem i wyglądem przypominają białe blaszki.
Zmiany, które występują u pacjentów już jakiś czas charakteryzują się pergaminową powierzchnią i towarzyszą im ogniska rogowacenia mieszkowego, które przypominają zaskórniki. Może również dojść do oddzielenie się naskórka od skóry właściwej i powstania pęcherza.
Liszaj twardzinowy lokalizuje się u kobiet m.in. w okolicach zewnętrznych narządów płciowych, a dokładniej sromu, krocza i obszaru okołoodbytniczego. Może prowadzić nawet do marskości sromu. Natomiast u mężczyzn schorzenie to dotyka najczęściej skóry żołędzia i napletka. Tworzące się w tych miejscach bliznowacenia, zniekształcenia czy krwotoczne pęcherze mogą być przyczyną odczuwania bólu podczas stosunku, zwanego dyspareunią. Może w tych obszarach również dojść do zapalenia żołędzi i stulejki. Pamiętajmy, że liszaj twardzinowy zlokalizowany w obrębie narządów płciowych może być potencjalną zmianą przednowotworową.
Wykwitom towarzyszy dokuczliwy świąd
Przyczyną powstania liszaja twardzinego są czynniki autoimmunologiczne, a także predyspozycje genetyczne. Aby potwierdzić diagnozę tego schorzenia należy przeprowadzić dokładne badanie dermatologiczne bądź pobrać wycinek do badania histopatologicznego (przy braku pewności).
Wyróżnia się kilka podtypów choroby, w tym twardzinę ograniczoną (morphea), postać ogniskową tocznia rumieniowatego (DLE), łuszczycę, bielactwo, liszaj płaski zanikowy oraz chorobę Bowena.
W celu uniknięcia zaognienia wykwitów ważne jest, aby zachować odpowiednią higienę i unikać środków drażniących.
Jakie środki są stosowane w leczeniu liszaja twardzinowego?
Leczenie wykwitów przy tej chorobie polega na leczeniu miejscowym 0,05% propionianem klobetazolu, doogniskową iniekcją kortykosteroidów (w przypadkach opornych na działanie 0,05% propionianem klobetazolu), inhibitorami kalcyneuryny oraz terapią UVA1/ PUVA-bath. Aby zniwelować uczucie suchości skóry pacjentom zaleca się zastosowanie lubrykantów.
Leczenie ogólne liszaja twardzinowego polega na doustnym stosowaniu retinoidów (Acitretina czy Izotretinoina), jednak pod ścisłym nadzorem lekarza.
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