Lichen Planus Flashcards
What are the different clinical presentations of LP
Reticular
Atrophic/erosive
ulcerative
What is LP
Tcell immune response to langerhan cells presenting an antigen and activatinf the immune response where the T cells bind and induce inflam. response
Histologically what is commonly seen in LP
Clear and classical T-cell infiltrate into the basement membrane area with a lymphocytic band hugging the basement membrane
Chronic Inflammatory cell infiltrate
Saw tooth rete ridges
Basal cell damage
Patchy acanthosis
Parakeratosis
Civatte bodies (dead keratinocytes)
What is difference between Oral Lichen Planus and Oral Lichenoid Tissue Reaction
Oral Lichen Planus: generalised and idiopathic
Oral Lichenoid Tissue Reaction: localised and may be a response to meidicnes/allergens
If a patient has a Oral Lichen Planus/Oral Lichenoid Tissue Reaction what questions are important to ask
ask about systemic symptoms or recent cancer therapy:
Lupus
Graft versus host disease
What is acanthosis
diffuse epidermal hyperplasia caused by the increased thickness of the stratum spinosum constituted by the prickle cells
What are the potetional causes of LP
Lymphocyte activation and Attempt to remove chronic irritation
Genetic predisposition
Physical and emotional stress
Injury to the skin; lichen planus often appears where the skin has been scratched or after surgery — this is called the isomorphic response (koebnerisation)
Localised skin disease such as herpes zoster—isotopic response
Systemic viral infection, such as hepatitis C (which might modify self-antigens on the surface of basal keratinocytes)
Contact allergy, such as to metal fillings in oral lichen planus
Drugs; gold, quinine, b-bloakcers, ace inhibitors
What drugs are thought to potetionaly cause OLR
Drugs causing OLR: Antihypertensives, Antimalarials, NSAIDS, Allopurinol, Lithium
How many pt have other areas affected
50%
What sites can LP appear
Buccal mucosa
Gingivae
Tongue – lateral aspect, dorsum
Lips
Palate
Whats the most common site of LP
Buccal mucosa
What is LP on the gingivae called and look like
desquamative gingivitis
very erythematous appearance (Similar clinical appearance to gingival pemphigoid and to plasma cell gingivitis)
How to treat Gingivae LP
OH very important in settling lesion
-Especially interdental
-Seems plaque driven in many patients
What are thought to be contributing factors to LP
Most are IDIOPATHIC – no known cause
Some related to MEDICATION
Some related to AMALGAM restorations
What medications can cause LP
ACE inhibitors
Beta-adrenergic blockers
Diuretics – Bendroflumethiazide, frusemide
NSAIDs
DMARDs -Penicillamine, Gold, Sulphasalazine
What do lichenoid drug reactions look like
More often widespread lesions
Often bilateral and mirrored
Often poorly responsive to standard steroid treatment
How would you manage LP
Remove any cause:
-Medicines
-Dental restorations
-Biopsy to get clear diagnosis
-Blood tests; Haematinincs, FBC, If lupus suspected autoantibody screen (ANA, Ro, dsDNA)
What would be management of OLP/OLR be
Symptomatic relief:
-Simple mouthwash (HSMW )
-Local anaesthetic (Benzydamine or lidocaine)
-Avoid trigger factors: Spicy foods, fizzy drinks
-Steroid mouthwash (Betamethasone m/w, beclometasone inhaler or hydrocortisone oromucosal tablets)
-Change restorations
-Onward Referral- Biopsy, inform of increased cancer risk, stopping the cause in OLR
How can you treat mild LP
over the couter remedies:
-Chlorhexidene m/w
-Benzdamine m/w
Avoid SLS containing toothpastes
-Sensodyne
How would you treat persisting symptomatic lesions
Clinical setting:
Topical steroids (as for Oral Ulcers)
-Beclomethasone MDI 0.5mg/puff – 2 puffs x 2-3 daily
-Betamethasone rinse – 1mg/10ml/2mins/twice daily
Hospital setting:
-Higher strength topical steroids
-‘Skin’ Steroid Cream – CLOBETASOL
Cream can be applied in a ‘veneer’ for gingival lesions
-Topical tacrolimus – ointment or mouthwash
-Hydroxychloroquine
-Systemic immunmodulators; Azathioprine, mycophenolate
What diseases can produce LP like lesions
graft versus host disease
lupus erythematosus
