EWMA 2013 - Ep511 - Lichen ruber verrucosus in patients with chronic venous insufficiency
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Transcript of EWMA 2013 - Ep511 - Lichen ruber verrucosus in patients with chronic venous insufficiency
1
Lichen ruber verrucosus
in patients with chronic
venous insufficiency
Hana Zelenkova, M.D. Ph,D.
Private Clinic of Dermatovenereology,
DOST Svidnik, Slovakia
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Chronic venous insufficiency
(CVI /CVO)
is a very common condition
of vayring severity, affecting 10 - 50% of
adult population
¾ of patients with CVO remain untreated
Pharmacological therapy is indicated
from the very first symptoms in order
to prevent progression
Pathological symptoms include oedema,
pain, heavy legs, cramps and cutaneous
changes
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Lichen ruber verrucosus
Is very stressful for the patient
First treatment is provided usually after
severe changes and manifestations have
already occurred
Both genders are affected alike, but
women seek medical attention more often
The itching is unbearable, some patients
scratch the foci raw, and allegedly only
then feel partial relief
Clinical pattern - appears predominantly on extensor areas of lower legs but also on the ankles of patients suffering from chronic venous insufficiency.
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Lichen ruber verrucosus
(lichen planus hypertrophicus)
The most prominent clinical manifestations include multiple firm papule-like foci of pea size and blending plaque-like foci in the size of a human palm
Elevated foci show the nature of hyperkeratosis verruciformis, and are of purple-red to brown-red colour, which appears mainly on the margins, while towards the centre the colour changes to white (chalk hyperkeratosis).
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Clinical manifestation
The manifestations itch severely, and heal by forming atrophic hyperpigmented scars. In the areas affected by verrucous lesions, chronic irritation (scratching) may lead to the development of verrucous carcinoma. It is therefore advisable to perform a histological examination
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Therapy
Systemic – should include topical antiflogistics and corticoids together with occlusion and compression dressings, retinoids, azelaic acid
Topical – venopharmacs, venotonics, antihistamine drugs, exceptionally corticoids, cyclosporine(?), Chlorochin (?) – secondary undesired system effects
The therapy must respond to the extent of the
condition and the subjective trouble of the patient
Topical application of ointments or tinctures even
in combination with occlusion only brings partial
relief and is thus insufficient
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Best effects are achieved with intra-focal corticoid injections
The anamnesis must be thoroughly inspected prior to injection!
Injection corticoids are contraindicated in patients on oral anticoagulants, pregnant women and are disputable in diabetics
Intrafocally administered 1-2 ml of drug according to condition
One application is usually enough
If necessary, another dose is injected in 1 month
We use betamethasoni dipropionas, betamethasoni natrii phosphas
8 Lichen ruber verrucosus - Intra-focal
corticoid injections - before therapy
and after 1 session - 56–year-old female
before after
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Lichen ruber verrucosus - Intra-focal corticoid
injections - before therapy and after 1 session
48-yer-old female, severely obese, treated
over 10 years due to lower leg oedema
before after
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Conclusion
Lichen ruber verrucosus is a very
discomforting dermatosis, which is also
difficult to treat
In case of diagnostic problems opt
for histological examination (to
exclude malignancy)
Intrafocal application of corticoids is very efficient
It brings instant relief and the pathology is gradually reduced
It is up to the dermatologist and
their erudition to choose this
possibility.