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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.