12 - Lichen planus overview

Question 1

Who are the patient demographic that develop lichen planus?

Answer 1

• 30-50 years
• 50% those who have skin lesions have oral lesions
• 10-30% those who have oral lesions have skin lesions

Question 2

What causes lichen planus?

Answer 2

• idiopathic
• drug related
• contact allergy (amalgam)
• stress
• viral can exacerbate

Question 3

What are the different patterns of lichen planus?

Answer 3

• reticular
• atrophic/erosive
• ulcerative

Question 4

Describe reticular lichen planus.

Answer 4

• lacy white pattern over mucosa
• underlying mucosa can be red or normal
• red signifies atrophy

Question 5

Describe atrophic and erosive lichen planus.

Answer 5

• begins as atrophic and red
• can become erosive as mucosa thins
• erosie has yellow fibrin base

Question 6

Describe ulcerative lichen planus.

Answer 6

Areas of normal mucosa and ulcerated areas, with yellow fibrin visible

Question 7

What is lichen planus histologically?

Answer 7

• chronic inflammatory cell infiltrate
• saw tooth rate ridges present
• basal cell damage
• patchy acanthosis
• parakeratosis

Question 8

How does skin lichen planus present?

Answer 8

• itchy red patches on skin
• red patches can have white reticular pattern overlying
• bald patches in hair
• nails affected

Question 9

What are symptoms of oral lichen planus?

Answer 9

• often none
• sensitivity to spicy/hot food (thinning of epithelium)
• burning sensation

Question 10

What are the most common sites of oral lichen planus (descending order)?

Answer 10

• buccal mucosa
• gingivae
• tongue (lateral and forsum)
• lips
• palate

Question 11

What is lichen planus on the gingivae described as?

Answer 11

Desquamative gingivitis

Question 12

How do you manage gingival lichen planus?

Answer 12

• OH is vital in settling lesions
• is plaque driven in many patients
• biopsy difficult but is often required for differential diagnosis form gingival pemphigoid

Question 13

Describe lichen planus on the dorsum of the tongue.

Answer 13

• usually idiopathic
• loss of papillae and smooth tongue surface

Question 14

Describe lichen planus on the lateral aspect of the tongue.

Answer 14

• may have drug or amalgam trigger
• look at tongue position at rest for an amalgam contact

Question 15

Describe lip lichen planus.

Answer 15

• can be red with reticular pattern
• requires biopsy
• requires suncream to protect from UV