Shiny zoster – what causes and how to treat

Brilliant called ringworm is a chronic skin disease that is manifested by granulomas – dense nodules. Pathology revealed less frequently than other forms of lichen. Its causes and mechanisms of development are still unknown.

Granulomas, which are formed by a brilliant lichen, very similar to the foci of productive inflammation, which is formed in tuberculous lesions, syphilis, sarcoidosis and some other diseases. Therefore, the diagnosis of confusion.

When an accurate diagnosis is made, patients in the literal sense relieved that they are not diagnosed with tuberculosis and not syphilis, but they do not take into account that for a brilliant depriving delayed, and treatment is purely symptomatic.

The positive aspect is that the rash of shiny shingles do not tend to spread to other parts of the body, so there is no risk of being strewn with granules.

General data

Shiny ringworm is a type of so-called moosalamoo dermatosis – non-inflammatory skin lesions, which occurs less frequently in comparison with other types of skin diseases in General and herpes in particular. In its manifestations is non-aggressive benign disease, which is characterized by chronic prolonged duration. Shiny ringworm known a little more than a hundred years, during this time, scientists have been unable to establish its etiological factors.

A feature of the disease is that primary elements (nodules), only appearing after some time develop back. This is a rather unusual process as in dermatology and in medicine in General, yet it can not be explained.

A characteristic feature of brilliant lichen is that it is most often diagnosed in boys of preschool and younger school age – from 3 to 9 years old (but adults get sick, too). Seasonality of the disease (occurrence in certain times of the year).

On the one hand a brilliant ringworm is not dangerous for life and health, on the other it causes some distress patients because it spoils the aesthetic appearance of the skin.

At the moment it is believed that brilliant versicolor is one of the varieties of lichen planus – pathology, which manifests as nodules on the skin and mucous membranes (namely in the mouth and on the red border of the lips).

There is evidence that brilliant versicolor may occur as a specific reaction to the presence in the body of the child of Mycobacterium tuberculosis. As the incidence of tuberculosis increases every year, for this reason there is growing clinical interest in the brilliant deprive. But, on the other hand, the incidence of this disease has not changed for at least the last few decades, therefore, some clinicians have questioned the appearance of lustrous lichen in response to tuberculous lesions in particular, and any external factors in General.

Brilliant Rob has another name – Lychen Pincus. He is named after the Clinician who first a hundred years ago described the characteristics of this disease.

Reasons

Accurate direct causes of lustrous lichen and the formation mechanism of their substrate (granulomas) have not been studied so far.

Most of all there is no evidence that the disease is of the nature:

• infectious;
• allergic;
• combined infectious-allergic.

The role of infection in the occurrence of the described pathology in children with brilliant ringworm is considered based on the following data:

• when examining a sick child in his body mandatory to identify the foci of infection;
• antibacterial therapy leads to a positive result – the size of granulomas decreased, granulomatous rash becomes less pronounced, a new granulomas do not occur, or at least appear in a limited number.

On the other hand, there is evidence for the allergic nature of the brilliant lichen: these patients have a history almost always reveals atopic dermatitis is a chronic noncontagious inflammatory skin lesion with lingering course, which is manifested by dryness of the skin, their increased irritation and intense itching, which indicates increased sensitivity of the organism.

They also study theory, which says that brilliant shingles can be the result of trauma to the skin. Endorsement of such approval is that often at the site of injury of the skin appear granulomas, characteristic of lustrous lichen.

The development of the pathology

The main feature of the disease is persistent (persistent) over – on the skin appear granulomas, which “lived” for some time (often short), disappear spontaneously, without any treatment, but in their place there are new granulomatous elements. Maximum in most cases, the granulomas do not apply beyond the boundaries of the “territory” of the skin, which they struck initially.

Characteristics of granulomas:

• form – rounded, rarely hemispherical, similar to millet seeds;
• in size, averaging 0.2-0.3 cm in diameter;
• consistency firmly-elastic;
• color – light;
• the variety is almost the same shape, size and consistency.

Distribution highlighted two basic forms of lustrous lichen:

• local granulomas appear on limited area of skin;
• generalized – rash covers quite an extensive region.

A special kind of local forms lustrous lichen is considered Palmar-plantar – with the formation of granulomas in the relevant areas of the hands and feet.

Often found in the local variety of lustrous lichen.

Generalized form mainly develops in adults and depends on such factors as:

• stressful situation;
• hypothermia;
• suffering a severe diseases and pathological conditions;
• endocrine disorders;
• infectious diseases.

Cases when the generalized form of the brilliant lichen developed on the background of sporadic (random) stressful situations, practically not observed.

The reason for its development is the chronic stress often associated with such circumstances as:

• adversity in the workplace;
• strained family relationships;
• social insecurity – financial difficulties, job loss, conflicts with friends

and so on.

So the people who visited the doctor with complaints about the appearance on the skin of many typical tubercles, should find out the history (story) of the disease – and not least the presence of chronic stress.

Also, a generalized form can be diagnosed in children of school age against the backdrop of stressful situations arising for such reasons as:

• an unhealthy situation in the school;
• transition;
• conflicts in the family

and others.

In some cases, brilliant shingles there are not granulomas and other types of skin lesions. Depending on them there are such rare forms of pathology described as:

• vesicular;
• hemorrhagic;
• punch
• merging.

When vezikulezny form of the disease on the skin formed small multiple vesicles, filled with transparent colorless liquid.

The hemorrhagic form of the brilliant lichen is characterized by bleeding from blood vessels located in the superficial layers of the skin.

Punching kind of brilliant depriving manifestoes minor injuries of the skin.

When merging the form described disease granulomas in the literal sense merge into a single “box” lesion.

These atypical varieties of brilliant lichen are extremely rare – but about the possibility of their development, it should be remembered, as they add confusion to the diagnostic process, and because of this morphological tipichnost there is suspicion that developed a brilliant ringworm.

From the point of view of fabric structure there are two types of the primary element is:

• a granuloma is the tubercle;
• granuloma inflammatory non-tuberculous origin.

These granulomas develop in the upper layers of the dermis, have sharply defined boundaries, they are composed of the following cell elements:

• lymphocytes – cells that support the local immunity;
• phagocytes – literally “cell eaters” that engulf foreign elements trapped in the body;
• the blasts – young cells, which develop new cell elements (in this case, providing cell-mediated immunity).

Old and new granulomas differ in their structure:

• recent tubercle has in its Central part of a blood vessel;
• in old tubercles at the edges of developing necrosis (tissue death).

Symptoms

In the classical form of the brilliant depriving the symptoms resemble the clinical picture of vulgar (common) lichen planus.

The primary element in the brilliant shingles in children is a granuloma with these characteristics:

• the nature of the nodule;
• the shape – oval, slightly flattened;
• the colors – from Nude to hot pink;
• in size – often up to 0.2 cm in diameter;
• the nature of the surface is shiny, without flaking;
• localization – mainly in the lower abdomen, the area of the external genitalia (glans penis), lateral (external) surface of the upper and lower extremities, in the elbow and knee bends. Rarely the primary elements of a brilliant depriving appear on the inner surface of the hands and feet, as well as in the mucosa of the oral cavity.

A characteristic feature of brilliant lichen is that it almost never affects the face and scalp.

The pathology is chronic. Granulomas can exist on the skin from a few weeks (sometimes days) to several years. Next, they independently, without any external influence and external causes capable of regress, then there are no clinical consequences of pathology (e.g., intoxication) and no trace on the skin. In this connection, shiny ringworm belong to the category of pathologies, manifested benign course.

Any subjective feelings described with the development of the disease are not observed – patients, regardless of age, do not complain n no pain, no discomfort, no itching in the occurrence of granulomas. Also not disturbed the General condition of patients (irrespective of which age category was affected – children or adults).

Diagnosis

In the case of the classical version of the brilliant depriving its diagnosis is not difficult – it is based on a physical examination of the patient with the identification of granulomas. Instrumental and laboratory diagnostic methods employed to confirm the diagnosis.

During physical examination are:

• during the inspection – assessment of shape, color, quantity, size, surface granulomas, any features of the rash. While looking around the skin on all parts of the body, carefully studied the places covered from the examination of physiological bends, folds and so on;
• palpation (feeling) – evaluation of the consistency of lesions and tissues in the neighborhood.

Using additional diagnostic methods (instrumental and laboratory) it is important to identify infectious and allergic component of the disease described.

Instrumental methods of research that can be applied in the diagnosis of lustrous lichen, is:

• fluoroscopy – x-ray examination of the chest. With it detected in lung lesions of a chronic infection, which may be involved in the development of brilliant depriving;
• biopsy – a tissue granulomas and their subsequent study under a microscope.

Also take care of specific skin tests to determine the degree of sensitization (sensitivity) of the organism.

Laboratory methods that can be informative in the diagnosis of lustrous lichen, is:

• General blood analysis – increased number of leukocytes (leukocytosis) and erythrocyte sedimentation rate may indicate the presence in the body infectious inflammatory process, which could become the background for the emergence of a brilliant depriving;
• urinalysis – increased number of white blood cells in the urine may indicate the development of kidney infectious-inflammatory process with similar effects;
• histological examination under a microscope study of tissue structure of the granulomas;
• cytological examination under a microscope, studying the cellular structure of granulomas.

Differential diagnosis of

Differential (distinctive) brilliant diagnosis of lichen is often carried out with such diseases and pathological conditions, such as:

• follicular hyperkeratosis (or the usual “goose bumps”) – increased keratinization of the upper layer of the epidermis, which does not have time to separate, thus the hair follicle is overlapping Horny scales, and under it accumulates sebaceous glands. When follicular keratosis it affected the entire skin, and the nodules are compacted hair follicles;
• lichen planus is a chronic dermatosis, characterized (and only) manifestation of which is a papule. In this pathology the papules larger and more vivid than brilliant with lichen, can be reborn into plaques;
• thorn ringworm (ringworm of Crocker-Adamson) is a rare benign dermatosis with the formation of papules that are composed of keratinized epithelial cells in hair follicles prone to draining. This disease is characterized by “a symptom of a grater” – when holding hands over the skin with rashes, it feels like touch to the grater;
• tuberculosis of the skin – damage to the skin by Mycobacterium tuberculosis with the formation of specific granulomas. Confirmed by the identification of TB germs in the body;
• syphilitic lesions of the skin – the formation of specific granulomas of the skin with the defeat of the pale Treponema. Confirmed by the identification of causative agents of syphilis in the body;
• follikuliarny Mucins – rare skin disease, manifested by degenerative changes in hair follicles and sebaceous glands with destruction of their structure and deposition of mucin (a substance with a gel-like consistency, which, in moderation, is produced by epithelial cells). The diagnosis in children and adult men, as well as, in contrast to the brilliant lichen, affects the scalp, the eyebrow area, and neck;
• sarcoidosis is a systemic formation of granulomas. Unlike the brilliant depriving patients have some goons on the deterioration since, in addition to lesions on the skin, affects other organs and tissues.

Complications

Brilliant lichen benign, without any critical consequences. The most significant “damage” that plagues the patient, is a cosmetic skin defect. Sometimes skin can be dermatitis as the result of the joined infection (due to the weakening of local immunity), but some clinicians dispute that relationship, considering that shiny ringworm and dermatitis develop autonomously, without being dependent on each other.

Treatment

Shiny zoster is a specific disease from those that are benign, do not cause subjective sensations and their manifestations (in this case, granulomas) tend to disappear without any external intervention. But the presence of primary elements spoils the aesthetic appearance of the skin, and therefore should not be ignored treatment, although it is symptomatic (that is, aimed at elimination of the disease and its consequences).

The goal of treatment for shingles is brilliant:

• sanitation (cleaning) of foci of chronic infection;
• the strengthening of protective forces of an organism.

Treatment when this happens:

• General;
• local.

The basis of the General treatment of a brilliant depriving based on the following assignments:

Vitamin therapy is carried out with the use of vitamins A, B1, C, D2, and multivitamins in the form of pharmaceutical complexes. Often the use of oral (through the mouth), but it periodically should be alternated with the injection introduction of one or another vitamin product. While still important in a balanced diet, in which the patient simultaneously receives a sufficient amount of vitamins from food.

Of immunostimulatory drugs in the treatment of depriving a brilliant proven:

and some other drugs.

As topical treatments are assigned:

• physiotherapy;
• therapeutic baths;
• ointment.

From physiotherapy drugs more often in the treatment of depriving a brilliant use of UV (ultraviolet radiation) lesions.

A positive effect was observed when patients alternated reception coniferous and baths with bran.

In the local treatment used ointment:

• resorcinol;
• salicylic;
• sulfur.

If the disease is especially persistent in nature, and granulomas do not disappear, shows the appointment of hormonal ointments.

Good results are observed with Spa treatment in specialized sanatoriums.

Prevention

As the true reasons for the development of a brilliant depriving is unknown, specific prevention methods are not.

To reduce the risk of disease (and in the case of its occurrence – to reduce the severity of the clinical picture) recommended:

• timely identification of the body of foci of chronic infection and their elimination. Most often it is tooth decay (destruction of tooth tissues), tonsillitis (inflammation of the tonsils with involvement in the pathological process of the Palatine arches), and others;
• relief of manifestations of excessive sensitization of the organism – in other words, the struggle with allergies;
• avoidance of skin trauma, and with her injuries – appropriate treatment;
• healthy lifestyle – balanced diet, regulated regime of work (school – children), rest, sleep;
• strengthen immunity with the help of hardening, sports and so on.

Forecast

The prognosis of brilliant lichen favorable – even without any medical interventions, the disease is capable of partially resolution. But granulomas spoil the aesthetic appearance of the skin, often provoking for this reason, moral suffering. So medical appointments are needed to reduce the symptoms of the described pathology. Contrary, it seemed that the favorable course of the disease should not self-medicate.