This document discusses lichen ruber verrucosus, a skin condition associated with chronic venous insufficiency that causes severe itching. It affects about 10-50% of the adult population and presents as firm, pea-sized papules and plaque-like lesions on the lower legs that are purple-red to brown in color. While topical treatments may provide partial relief, intra-focal corticoid injections directly into the lesions are the most effective therapy, bringing immediate relief and gradually reducing the pathology. The injections are generally safe and well-tolerated, with one session often being sufficient treatment.

1. 1
Lichen ruber verrucosus
in patients with chronic
venous insufficiency
Hana Zelenkova, M.D. Ph,D.
Private Clinic of Dermatovenereology,
DOST Svidnik, Slovakia

2. 2
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

3. 3
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.

4. 4
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).

5. 5
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

6. 6
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

7. 7
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

8. 8
Lichen ruber verrucosus - Intra-focal
corticoid injections - before therapy
and after 1 session - 56–year-old female
before after

9. 9
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

10. 10
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