Lichen Planus Flashcards
What is Lichen Planus?
- Chronic inflammatory disease
- Affects approx 1% of pop
- Mainly 30-50 age
- Can be idiopathic or drug related
In lichen planus Skin cases what is the percentage you are also likely to have oral lesions?
- 50%
In Lichen Planus oral cases what is the percentage with skin lesions?
- 10-30%
What type of Lichen Planus is this?
- Reticular
What type of Lichen Planus is this?
Atrophic / erosive
What type of Lichen planus is this?
- Ulcerative
What are the Oral lichen planus sites?
- Buccal mucosa
- Gingivae (Desquamative Gingivitis)
- Tongue (lateral aspect, dorsum)
- Lips
- Palate
What is the most common oral site for Lichen planus?
- Anywhere on Buccal mucosa but more likely on
- Anterior at commisure
- Mid
- Posterior around 3 rd molar tooth
- An easy biopsy site
When found in Isolation what is Gingival Lichen planus also called?
- Desquamative gingivitis
- Has very erythematous appearance
What other diagnosis does desquamative gingivitis have a similar clinical appearance to?
- Gingival pemphigoid
- And plasma cell gingivitis
(Histology important to tell the difference)
Why is a biopsy for gingival lichen planus difficult?
- Risk of damaging attachment area of gingiva/tooth
- Adherent attached mucosa damaged lifting from bone
What is very important in settling gingival lichen planus?
- OHI
- Esp interdental
- Seems plaque driven in many pts
What is the presentation of gingival lichen planus?
- Can be patchy
- Some forms more ‘typical’ reticular pattern
- Varies
What lichen planus is this?
- Gingival lichen planus
When Lichen planus is found on the Dorsum of the tongue what is its trigger?
- Usually idiopathic
- Loss of papillae and smooth tongue surface
When Lichen planus is found on the lateral aspect of tongue what is the trigger usually?
- Drug or amalgam trigger
- Amalgam most likely if there is isolated lateral tongue lesion
- Drug if multiple lesion
What do you need to caution the pt when receiving a tongue biopsy?
- Easy procedure
- Painful when healing
What is this an example of?
- Tongue lichen planus
What is this a type of ?
- Lip lichen planus
During a lichenoid reaction what occurs histologically?
- Chronic inflammatory cell infiltrate
- Saw tooth rete ridges
- Basal cell damage
- Parakeratosis
Describe what is going on histologically in this picture
What are the symptoms of lichen planus?
- Often none
- May relate to thinning of epithelium so will be sensitive to hot/spicy food or have a burning sensation in the mucosa
What other sites of the body can be affected by Lichen Planus?
- Skin
- Scalp
- Genital
- Hair
- Nails
Histologically what disease is this picture showing?
- Lichen planus
- Clear T cell infiltrate into the basal membrane area of connective tissues
- The dark purple lymphocytic band hugging the basement membrane is key diagnostic feature of LP
Describe this Lichenoid reaction
- Chronic inflmmatory cell infiltrate (T cell)
-Saw tooth rete ridges - Basal cell damage
- Patchy acanthosis of epithelial layer
- Parakeratosis of superficial epithelium
Using what occurs histologically what info does this give us in regard to Lichen Planus as a disease?
- Shows lymphocyte activation which means the body is attempting to remove a perceived threat
- Most likley the langerhans cells in epithelium are presenting an antigen which triggers an immune response (T lymphocytes) to remove chronic irritation - causing change in epithelium
- Lichen Planus does not have singular cause
What are some other thoughts to cause of LP?
- Genetic predisposition
- Physical and emotional stress
- Injury to skin called koebnerisation
