Lichen Planus Flashcards
information on lichen planus
* histologically
* mechanism of aciton
- chronic disease
- mainly 30-50yo
- skin = 50% chance oral
- oral = 10-30% chance skin
- causes = idiopathic or drug related
- can last between 10 and 15 years
- histologically - t lymphocyte infiltration into basal layer of mucosa, saw tooth rete ridges, basal cell damage, patchy acanthosis, parakeratosis, civatte bodies (dead kaeratinocytes within alive layers)
- mechanism - immune cells chronically present as of percieved threat (langerhans cells present antigen which activates an immune response) -can be final common pathway of many irritations in the epithelium that ends up amounting to lichen planus
types of presentation of lichen planus
- Reticular
- erythematous
* atrophic lichen planus
* erosive/ulcerative lichen planus
managment and treatment for lichen planus
- remove any cause (medicaiton / restorations)
- biopsy
- blood tests (haematinics, FBC and autoantibody screen if suspect lupus)
- Treat by the symptoms - generally ucleration tx
- mild = benzdamine MW and chlorhexidine MW AND avoid SLS containing toothpaste
- severe = STEROIDAL - beclomethasone MDI or betamethasone rinse
- veneer gingiva with thermoplastic casing to hold steroid on gingiva
- extremely severe in a hospital setting - higher strength topical steroids (betamethasone and beclomethasone), hydroxychloroquine, systemic immunmodulators (azathioprine, mycophenolate)
factors promoting the development of lichen planus
- stress
- gentic predispsition
- truama (isomorphic response)
- local herpes zoster (isotopic response)
- systemic viral infeciton (hep c - modifies self antigens on surface of basal cells)
- drugs (gold, b-bloackers, ace inhibitors)
symptoms of lichen plaus
- most often none
- relative to thinning of epithelium (sensitive to spicy food and burning mucosa sensation)
what body parts can lichen planus effect
- mouth
- scalp
- genital
- hair
- nails
where can lichen planus appear in the mouth
- buccal mucosa
* most common
* easy biopsy
- - Gingiva
* called desquamative gingivitis
* similar to gingival pemphigoid and plasma cell gingivitis - histology diagnoses
* very erythematous
* OH important
* hard biopsy
- tongue
- dorsum usually asymptomatic - lose papillae and smooth
- ## lateral likely caused by drugs or amalgam
- lip
- erythematous and crusting
- use sun block as sun can trigger
medicaitons that can increase chance of lichen planus
- ace inhibitors
* for high BP
* …Pril (ramipril etc)
- - beta adrenergic blockers
- for post heart attack and arrhythmia patients
- …olol (metoprolol etc)
- - diuretics
- NSAIDs
- DMARDS
- others - gold, penicillamine, sulphasalazine
difference in meaning between lichen planus and lichenoid reaction and the difference in appearance
Oral lichen planus (OLP)
- The idiopathic chronic autoimmune reaction where t lymphocytes damage the basal cells
oral lichenoid reaction (OLR)
- a lesion the same as a lichen planus lesion however the cause is known and can be removed
difference
- OLR more likely to be bilateral
- OLR more likely to be wide spread
- OLR has poorer reaction to steroid tx
managment of oral lichenoid reactions
* medication induced
* amalgam induced
- weigh symtoms and the benfit of the drug / risk of stopping it
- DISCUSS with GP
- could swap to another drug
- remove restoration and replace with comp.
- consider mercury / amalgam patch test prior to replacement
- dont need to replace other amalgams
important points in amalgam removal
- ruber dam and high volume aspiration for vapour
- avoid during pregancy
- especially when lcihenoid reaction
what reactions look loke lichenoid reactions?
- GVHD
* bone marrow transplant - this targets the hosts tissue as if foreign, rejects the host, INDICATION = lichenoid reaction ON PALATE
- - lupus erthematosis
* histologically = lyphocytic infiltrate much deeper in the lamina propria
* mouth only = discoid lupus (no antibodies)
* elesewhere also = systemic lupus ANA/dsDNA/Ro antibodies in blood
