Pink lichen of Gibert (roseola flaking) is an acute dermatological disease characterized by the appearance of pink spots on the skin of the trunk and limbs, located along the Langer lines and gradually acquiring the appearance of medallions. Typically, the onset of the disease begins with the appearance of one maternal plaque on the skin of the trunk and its completion within 1-1.5 months. Zhiber’s pink lichen is diagnosed using dermatoscopy, scraping for pathogenic fungi, luminescent diagnostics, blood tests for syphilis and biopsies. Treatment consists in the exclusion of irritating effects on the skin, the use of antihistamines, corticosteroid ointments and indifferent “chatterboxes”.
General information
Pink lichen of Gibert is included in the group of polyethological skin diseases, which are united by a single name – “lichen“. This group includes red flat lichen, shingles, ringworm and pityriasis. Typical elements in these diseases are itchy spots, differing in their shape, location, morphological features and the nature of the course.
Pink lichen Gibera is most common among people 20-40 years old. In the elderly and children under 10 years of age, cases of the disease are extremely rare. A significant increase in the incidence rate in the spring and autumn periods is typical for pink lichen. Such seasonality is also characteristic of colds, against which pink lichen usually occurs.
Causes
The exact causes and pathogenesis of Zhiber’s pink lichen have not yet been determined. The infectious-allergic nature of the disease is assumed, and therefore modern dermatology classifies it as a group of infectious erythemas. The infectious theory is confirmed by the detection of a positive reaction to intradermal administration of streptococcal vaccine in patients with Zhiber’s pink lichen. However, most authors are inclined to the viral genesis of the disease, since its cases most often occur after acute respiratory infections. Some researchers claim that the pink lichen of Gibert causes herpevirus type 7.
Symptoms
According to various data, 50-80% of patients with pink lichen of the Gibera begins with the appearance on the skin of one (less often 2-3) maternal plaque. It is characterized by a bright pink color, a flaky surface and a large size of about 3-5 cm in diameter. After about 7-10 days, multiple rashes are observed on the skin in the form of small pink spots having an oval or rounded shape. Their typical localization is the skin of the limbs and trunk. Usually, the maternal plaque appears on the chest, then the rash spreads to the abdomen, groin, hips, shoulders, arms, legs and neck. A distinctive feature of the pink lichen of Gibert is the location of the rash elements along the Langer lines — conditional lines along which it is possible to achieve maximum stretching of the skin.
Spots of pink lichen within a few days increase in size to 2 cm or more, but at the same time they practically do not merge with each other. Their central part becomes yellowish in color, its stratum corneum begins to peel off with the formation of small scales. At the same time, its pink color is preserved along the edge of the spot and there is no peeling, which gives the elements of pink lichen the appearance of medallions. The period of appearance of new rashes takes an average of 2-3 weeks. Then the spots gradually fade and disappear, leaving depigmented areas or hyperpigmentation on the skin. Over time, the skin in these places acquires a normal color.
In half of the patients, pink lichen of Gibert proceeds with a slight itching, 25% of the patients do not observe any subjective sensations. About a quarter of patients complain of severe itching, which may be due to additional skin irritation or increased neuropsychiatric lability of the patient. Sometimes, during the progression of rashes, the patient may experience slight increases in body temperature, general malaise, and an increase in submandibular and cervical lymph nodes.
The peculiarity of the flow of pink lichen of the Gibber is its clearly limited duration. With or without treatment, recovery occurs after 6-8 weeks. Relapses, as a rule, are not noted. There are clinical variants of pink lichen of Giber with a spotty-urticar or spotty-papular rash. They usually take longer.
In rare cases, complications may develop: infection of foci of pink lichen with the development of pyoderma, hydradenitis, folliculitis, ostiofolliculitis, streptococcal impetigo or their eczema with a gradual transition to eczema. Most often, the cause of complications is frequent washing or rubbing of the skin, irrational local therapy, excessive sweating, a tendency to allergic reactions.
Diagnostics
In typical clinical cases of pink lichen Giber, a dermatologist’s examination and dermatoscopy are sufficient for diagnosis. In cases where the rash of pink lichen Giber persists for longer than 6 weeks, a skin biopsy is taken and its histological examination is performed to exclude parapsoriasis. In case of infectious complications, a scrape or a discharge from the lesion is taken and its back-sowing is performed.
For the differential diagnosis of pink lichen of Giber from pityriasis, luminescent diagnostics and a study of skin scraping for pathogenic fungi are carried out. The manifestations of pink lichen can be similar to secondary syphilis. In such cases, to exclude the latter, an RPR test for syphilis is performed.
Treatment
Pink lichen of Gibera in most cases passes on its own and may not need treatment. In order to avoid complications, patients are recommended to adhere to a hypoallergenic diet for the duration of the disease, limit water procedures, eliminate skin friction with a washcloth, avoid using body cosmetics, wear only cotton underwear.
With severe itching, antihistamines are prescribed orally, corticosteroid and antipruritic ointments externally. Apply indifferent water-shaken external agents (zinc oxide). According to some dermatological studies, the use of erythromycin and acyclovir from the first days of the disease gives a good effect in pink lichen of Gibert. Such treatment contributes to a faster recovery without the development of complications.