Skin lichen symptoms and treatment

Skin lichen symptoms and treatment

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The term "skin lichen" describes various types of inflammatory skin diseases that are characterized by a slightly scaly rash. In many cases, itching and reddening of the skin also occur, which can make a lichen extremely uncomfortable and stressful for those affected. The scaly skin is often caused by an infection with so-called "filamentous fungi" (dermatophytes). B. also hereditary factors, autoimmune diseases or an infection with certain herpes viruses ("floret lichen").

Risk factors

There are a number of risk factors, e.g. can promote the onset or worsening of the disease in the case of common psoriasis. These include stress, improper nutrition, smoking, alcohol consumption, certain medications or external mechanical stimuli such as pressure or injuries. If the lichen on the skin is recognized early, it can usually be treated well with local therapy with preparations containing cortisone or anti-fungal agents (antifungals). Some diseases such as psoriasis, on the other hand, often takes a chronic course and occurs in batches. Accordingly, it is particularly important here to avoid risk factors and to properly care for the stressed skin, whereby naturopathy can offer helpful support.

Types of skin lichen

The term "lichen" describes different types of inflammatory skin diseases, all of which are characterized by a rash with a finely scaly surface, which clearly distinguishes itself from healthy skin. The name goes back to the similarity with the structure of the lichen (e.g. on tree bark) from the plant world, although in the biological sense it is not a question of plants, but of fungi (fungi).

A common variant of skin lichen is e.g. Nodule lichen (lichen planus), other forms include psoriasis, rose lichen (pityriasis rosea) and other skin fungal diseases (dermatomycoses) such as the so-called "beard lichen" or bran fungus.

To a certain extent, a fungal colonization on the skin is quite normal and harmless, because the body is normally able to successfully combat an unhindered multiplication through its natural defense system. Mushrooms only become dangerous if they can multiply uncontrollably, which is e.g. may be caused by excessive sweating or a weakened immune system as a result of a chronic illness, regular medication or malnutrition.

Nodular lichen

A comparatively common form of skin lichen is the so-called "nodule lichen" ("lichen planus"). This inflammatory skin disease usually occurs between the ages of 30 and 60 and manifests itself in the form of a build-up of (initially) reddish to (later on) violet-brownish, itchy, flat skin nodules (papules) that matte or have a wax-like sheen and are sharply defined.

The papules are slightly raised and flattened in the upper area, often after a few weeks there are also fine whitish, net-like lines on the surface (Wickham stripes). In most cases, the nodules appear on the flexor side of the forearms and wrists, but also in the area of ​​the ankles, loins and in the sacrum region and on the lower leg. The trunk is also less often affected, and in the case of a severe course the whole body can also be “strewn” with the pin-sized nodules.

The strongly itchy rash usually represents a great burden for those affected, in addition to that mechanical stress such as Scratching the skin is also irritating, which quickly leads to an intensification of the symptoms and the formation of new nodules on areas of the skin that were not previously affected. In addition to the skin, the lichen planus papules can also affect the mucous membranes (lichen planus mucosae), which leads to whitish discoloration or painful open areas. Here the cheek mucosa and the side surfaces of the tongue are most often affected, but white nodules on the palate, gums or on the back of the tongue are also possible.

Less often, lichen planus can also develop in the genital area, often in men in the area of ​​the glans, and in women on the inside of the large or small labia. In addition, it is possible that the reticular, whitish lines or small nodules - regardless of gender - also appear in the anal area, whereby in the case of severe inflammation, there may also be oozing superficial injuries to the skin (erosions). Due to the lichen planus in the genital and / or anal area, many sufferers suffer from very unpleasant symptoms, such as an itchy vagina, itchy anus or severe burning sensation, these symptoms often occurring in combination.

Infestation of the hair is also possible (lichen planus follicularis or planopilaris), which causes flaking of the skin and sometimes even hair loss. In addition, changes in the fingernails and toenails appear in some patients, e.g. Longitudinal grooves, dimples, splits or growth disorders occur. Thinning or brittle nails are less common here, which in some cases means that they are permanently damaged and ultimately fail.

The trigger for the typical skin changes in a lichen planus is the inflammation of the skin, which is caused by certain cells of the immune system attacking the bottom layer of the epidermis and destroying the bottom cell layer. However, the cause of this process is still unknown, but it is often suspected that it is an autoimmune disease that causes the immune system to incorrectly attack its own skin cells.

In addition to hereditary causes as well as chemicals or pharmaceuticals (e.g. antibiotics, water tablets or medications for high blood pressure) are considered as causes, as are viral diseases of the liver (viral hepatitis), concomitant diseases such as diabetes, increased cholesterol or uric acid levels, contact allergies (if the oral mucosa is affected) ) against gold, amalgam, ingredients of toothpaste or similar as well as psychological factors such as persistent stress, conflicts etc. are possible.

Skin lichen / rash on the face

If there are reddish, scaly patches in the area of ​​the facial hair, these can indicate beard lichen (medically "tinea barbae"), a skin disease (mycosis) caused by certain fungi that only affects men. The fungi are so-called "filamentous fungi" (dermatophytes), which lead to a specific infection of the skin and, in contrast to other fungi, only feed on carbohydrates and keratin. Accordingly, dermatophytes only affect areas of the body that contain keratin, such as skin, hair or nails, where they cause the typical round, slightly scaly reddish spots, which sometimes wet and often cause severe itching.

Since the initially round spots often combine with the hair follicles at the hairline, many men develop small knots or pustules, which quickly lead to an abscess or even purulent inflammation of the hair follicle and the associated tissue (boils or carbuncles ) can develop further. Although the skin disease is called "beard lichen", the beard itself is not a prerequisite for the development and the further course, instead there is not even one for many affected people.

In most cases, the filamentous fungi are the species "Trichophyton mentagrophytes" or "Trichophyton verrucosum", which are primarily transmitted by rodents or cattle. This is why men with beard lichen who live in rural areas or who have close contact with the relevant animals are often affected. Usually enough for an infection e.g. scratching the cheek after touching an infected animal briefly with the hand.

To make matters worse, the fungi are not only very contagious, but also survive for years and are exposed to external influences such as withstand high temperatures. Accordingly, the body's immune system plays a central role in the defense against pathogens, while infection is thus facilitated by an immune deficiency due to diabetes, poor circulation, certain medications or "immunosuppressants" (such as cortisone) etc.

Rose lichen

Another common form of skin lichen is the so-called "floret lichen" (pityriasis rosea), which is a harmless, but usually very unpleasant, inflammatory skin disease. A single oval redness is characteristic here, e.g. on the upper body, which is about the size of a coin, slightly raised and sharply delimited and slightly scaly ("primary medallion"). Of this, numerous further reddenings usually spread within the period of 7-14 days, mostly on the upper body, but also on the upper arms and thighs, face - hands and feet are usually not affected.

Finally, the upper part of the body is often almost “littered” with stains, which are mostly itchy or not at all and are significantly smaller than the primary medallion. Itching only occurs when the skin e.g. Frequent showering or excessive sweating removes moisture. In addition to this, there are more rare symptoms such as a general feeling of illness, constant tiredness and fatigue, headache and / or loss of appetite.

The exact causes of pityriasis rosea have not yet been clarified, but experts suspect that infection with certain herpes viruses (HHV-6, HHV-7) and genetic disposition are common. Stress and allergies are also sometimes considered to be beneficial factors, but this has also not been proven. However, it is clear that floret lichen can occur in children and adults alike, with children or adolescents and younger adults between the ages of 10 and 35 most often affected.


In addition, psoriasis, which is a common, non-contagious disease that is chronic in most cases, comes into consideration in the case of psoriasis-like skin changes. Characteristic here are red, raised skin areas, which are covered with shiny, silvery-whitish scales. The foci of psoriasis ("plaques") can be very small in some cases, but usually they are at least as large as a coin and can appear isolated and sharply delimited, as well as growing together over a large area (psoriasis geographica).

Itching is typical, and the skin is usually very dry and cracked. In general, the disease primarily occurs on the extensor sides of the arms (elbows) and legs (shin area, kneecap) and on the scalp, buttocks, chest, back, armpits, the navel or the area of ​​the genital organs or the anus can also occur to be affected. In many cases, in addition to the skin, the nails are also affected (nail psoriasis), which in turn leads to symptoms such as small, round depressions (“spotted nails”), thickened nail subcutaneous tissue and crumbly or extremely brittle nails.

Psoriasis is a so-called "autoimmune reaction", in which the body's defense is directed against its own body cells. So far, what has triggered this reaction has only been partially researched. However, it is certain that the susceptibility to the skin disease is inherited. However, the form is not inherited, which means that both parents may not show any symptoms, while psoriasis does appear in the child.

Accordingly, the genetic makeup alone is apparently not sufficient to trigger psoriasis; instead, additional risk factors must be added so that it occurs for the first time or is exacerbated in the case of an existing disease. These include external mechanical stimuli (e.g. pressure, skin injuries) as well as "internal" influencing factors such as stress, alcohol, smoking, improper nutrition or medication such as interferon or beta blockers.

Infectious diseases, obesity, hormonal changes (puberty, pregnancy, menopause etc.) or climatic conditions can act as triggers. Accordingly, basically anyone who is genetically predisposed can develop psoriasis, which in principle can happen at any age. Nevertheless, the majority of those affected suffer from “Type I” or “Early Type” psoriasis vulgaris, which occurs before the age of 40 and peaks between the ages of 15 and 25. A first outbreak in early childhood and in the elderly, however, is rather rare.

The course of psoriasis varies from person to person, usually the lichen appears chronically in the form of recurrent episodes. As a result, in many affected people, phases with strong symptoms alternate with those that are (almost) symptom-free, whereby the unpredictable course often leads to enormous psychological stress. The lichen often improves in the warm months due to the sun's rays, while e.g. Obesity (overweight) can aggravate the symptoms.

Skin fungus

Circular, brownish spots on the skin, which mainly appear on the back and chest, can also indicate a so-called "bran fungus lichen" (medical: "pityriasis versicolor"). This is a non-contagious fungal disease of the skin, which is mainly caused by the yeast "Malassezia furfur". The infection causes painless spots in this type of lichen, which are lighter in people with a rather dark complexion (Pityriasis versicolor alba) and darker (Pityriasis versicolor rubra) than the rest of the skin.

The size of the spots can vary widely, so that they only appear the size of a lens, but can also cover the skin like a map. In addition, there is less frequent a slight itching, then it is scratched at the affected area, usually fine, bran-like scales are released on the surface, which is why this skin disease is called "bran fungus lichen".

The yeast Malassezia furfur is part of the natural skin flora in almost all people, with the scalp being the main pathogen reservoir. Here the fungus feeds primarily on the fatty substances in the sebum and does not normally lead to changes in the skin. In some cases, however, there is an abnormal (pathogenic) multiplication of the fungi, which leads to the outbreak of the bran fungus.

The reasons for this development have not yet been fully elucidated, but a number of risk factors are known that can apparently favor pityriasis versicolor. These include, for example, a warm and humid climate, profuse sweating, an inherently oily skin as well as high-fat creams and lotions, because here the mushroom finds ideal growth conditions thanks to a lot of fat and the warm and humid environment.

In addition, bran fungus can be triggered by stress, wearing synthetic clothing, poor hygiene or certain medications (birth control pills, antibiotics, etc.), as well as a weakened immune system and certain underlying diseases such as diabetes mellitus. Because a warm, humid climate promotes the multiplication of the Malassezia furfur fungus, bran fungus is particularly common in tropical climates, where, according to the Institute for Quality and Efficiency in Health Care (IQWiG), up to 40% of people are affected in some cases. In countries with a temperate climate, however, according to the IQWiG, the skin fungus only develops in an estimated one percent of the population, with younger adults in particular suffering from the skin spots.

If pityriasis versicolor is treated with antifungal agents (antifungals), it usually takes a favorable course in that the symptoms disappear and the darker or lighter colored skin areas adjust to the normal skin color. However, since the lichen often recurs even after successful treatment, a permanent treatment of the scalp is usually recommended to prevent recurrence, on which the pathogen Malassezia furfur is particularly often found.

For this purpose, for example, special shampoos with fungicidal agents are suitable, which are used for everyday hair washing like conventional care products. In addition, those affected should pay attention to growth-promoting factors such as avoid airtight clothing, sweaty activities or high-fat body lotions. If the treatment of bran fungus is absent, pityriasis versicolor usually becomes chronic, which means that it suddenly occurs again and again, especially in the warm summer months.

Treating skin lichen: medication

In the case of skin lichen, it is first important to perceive the scaly patches as warning signals from the body as early as possible and to have the cause examined by a dermatologist. The visit of the specialist should take place as soon as possible, because a lichen can spread quickly and become a massive burden for the person concerned. In the case of a normal course, the treatment of a skin lichen usually takes place initially by local treatment of the affected skin areas. Depending on the cause of the lichen, special creams, lotions and ointments with different active ingredients are used, e.g. Cortisone, urea, clotrimazole or methotrexate.

Other local treatments, such as e.g. the light (bath PUVA therapy), cold (cryotherapy) or laser therapy used. In the case of very severe courses of courses, an internal (systemic) therapy may also be necessary, in which the active ingredients are absorbed into the body via tablets or injections and thereby develop their effects throughout the organism.

In exceptional cases, a combination of local and systemic therapy may also be indicated, while other forms of skin lichen often do not require any special treatment at all. Is it e.g. Lichen planus (nodular lichen) usually heals itself after a few weeks or months.

In addition, there are various therapeutic options that can be used depending on the type and severity of the disease. For the treatment of individual, smaller areas of skin, e.g. Usually short-term cortisone ointments or cortisone patches in question, in the case of extensive or rash-like infestation, therapy with cortisone tablets can have a positive effect on the healing process. However, care should generally be taken that the anti-inflammatory agents are not used over a long period of time and only in consultation with the doctor in order to avoid side effects of cortisone such as thin skin or red facial veins.

In addition to that come other local forms of treatment, such as a special form of light (PUVA therapy) or cold therapy (cryotherapy) is used, cooling envelopes, ice cubes or gel cushions often have a beneficial effect against the strong itching. In some cases, antihistamines can also help, but it is particularly important not to scratch the affected areas of the skin despite the strong itching, so as not to aggravate the symptoms.

If the oral mucosa (oral lichen planus) is affected, special cortisone preparations can also be used, here it is also particularly important to avoid additional irritation. Accordingly, the consumption of acidic, hot and spicy or spicy foods and drinks as well as nicotine and alcohol should be avoided and thorough dental and oral care should be taken. In addition, it is advisable to have dentures checked by a doctor and, if necessary, replaced, since these, like caries, can also promote or worsen lumps of the nodules (“Köbner phenomenon”).

If the symptoms are due to a lily of the rose, the scaly lichen usually also heals within 8-10 weeks without further treatment and does not leave any scars or the like. To support this, however, air-impermeable clothing and heavy sweating through sports, sauna, hot bathing and showering etc. should be avoided in order to prevent heat build-up, which can lead to additional irritation of the lichen and thus to massive itching and severe inflammation.

Against the itching, e.g. Preparations with the active ingredient polidocanol or weakly effective cortisone-containing agents are used, in addition, light therapy (phototherapy) can in some cases support the healing process. Before the red spots are treated “on your own”, they should always be clarified medically, because there are numerous causes for scaly redness on the upper body, so that there is not always a rose lichen.

Home remedies for skin lichen

In addition to conventional medicine approaches and procedures, there are a number of sensible home remedies to treat skin lichen naturally and to relieve symptoms such as itching or reddening of the skin. In many cases, for example, washing the affected areas with chamomile tea several times a day helps, lukewarm wraps with tar bran or healing earth can also help to soothe the skin and relieve the itching. Cooling compresses (ice cubes, moist envelopes etc.) have also proven effective against itching, as has a paste of honey and cinnamon or honey and chopped garlic, which is applied thinly to the itchy area.

A well-known home remedy for psoriasis are buttermilk compresses, for which a cloth is simply soaked in buttermilk and placed on the affected skin for about 20 minutes. As with neurodermatitis, an ointment or oil mixture with real lavender oil can also have a nourishing and beneficial effect.Furthermore, other medicinal plants and herbs such as e.g. Birch bark, hay flowers, sage, thyme or juniper.

The wild pansy is well suited for the treatment of skin lichen or acute and chronic skin diseases, since it contains, among other things, flavonoids and saponins, which on the one hand promote the metabolism and on the other hand have an anti-inflammatory effect. For external use we recommend e.g. an infusion, which is used cooled for envelopes. For this, 1.5 grams of dried pansy herb (from the pharmacy) are brewed with 150 milliliters of water and left to stand for five minutes. For internal treatment, a tea cure can also be an effective aid for skin lichen. Here, 2 teaspoons of dried pansy herb (1 teaspoon for children) are poured with 250 ml of boiling water and poured off after ten minutes of brewing. Adults drink 3 to 4 cups of the finished tea each day for eight to ten weeks, children receive one cup each morning and evening for about eight weeks.

In order to best prevent skin lichen, an intact, strong immune system is important, which acts as a "protective shield" and can successfully fight pathogens. Accordingly, attention should always be paid to a healthy, balanced diet with lots of whole grains, fruits and vegetables, as well as sufficient sleep and exercise or physical activity. Stress can also affect the immune system, because when stress hormones are released, the body automatically reduces the production of immune cells. As a result, susceptibility to pathogens that would have "had no chance" under normal circumstances increases.

Even if hectic, inner restlessness, pressure and tension cannot be completely avoided in everyday life, consciously used relaxation exercises can help to reduce stress and thereby support balance and a feeling of inner balance. Here are various processes and techniques such as progressive muscle relaxation, meditation, autogenic training or yoga, psychotherapy can also be useful in some cases, e.g. understand the causes of chronic stress and learn coping strategies. (No)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dipl. Social Science Nina Reese, Barbara Schindewolf-Lensch


  • Merck and Co., Inc .: Lichen ruber planus (knot lichen) (accessed: August 13, 2019), msdmanuals.com
  • Deutsche Haut- und Allergiehilfe e.V .: Patient information for nodular lichen - Lichen planus (accessed: August 13, 2019), dha-allergien.de
  • Deutscher Psoriasis Bund e.V .: Psoriasis (accessed: August 13, 2019), psoriasis-bund.de
  • German Dermatological Society (DDG): S3 guideline therapy for psoriasis vulgaris, status: October 2017, detailed guideline view
  • Medical center for quality in medicine: Psoriasis - psoriasis of the skin (available: 08/13/2019), patient-information.de
  • Amboss GmbH: Pityriasis rosea (scaling rose) (accessed: August 13, 2019), amboss.com
  • Prof. Dr. med. Peter Altmeyer: Pityriasis rosea L42 (accessed: August 13, 2019), enzyklopaedie-dermatologie.de
  • Centers for Disease Control and Prevention (CDC): Types of Fungal Diseases (accessed: August 13, 2019), cdc.gov

ICD codes for this disease: B35, B36, L40, L42, 43, L66ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.

Video: Lichen Planus: Symptoms and Treatment (July 2022).


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