Lichen Planus Flashcards
1
Q
Summary for Lichen Planus?
A
- chronic disease
- 1% of population
- periods of disease activity, might have lichenoid changes in mouth with no symptoms
- age 30-50, may last 10-15 years
- if pt has oral lesions, 50% may have skin lesions
- if pt has skin lesions, 30% chance of having oral lesions
- idiopathic, no obvious cause; can be related to drugs or systemic disease
2
Q
Reticular LP
A
- lacy pattern of white lines running across the mucosa
3
Q
Atrophic/ erosive LP
A
- yellowish fibrous covering over the base of connective tissue
4
Q
Ulcerative LP
A
- unpleasant and painful lesions
5
Q
What is Lichen Planus?
A
- histologically it has a clear and classical T cell infiltrate into basement membrane of CT
- lymphocytic band hugging the basement membrane is one of the key diagnostic features of LP
6
Q
Commonly seen in LP histology
A
- chronic inflammatory cell infiltrate
- saw tooth rete ridges
- basal cell damage
- patchy acanthosis
- parakeratosis of superficial epithelium
7
Q
Civatte bodies
A
- presence of dead keratinocytes, called Civatte bodies
8
Q
What does the histology tells us about LP?
A
- lymphocyte activation
- Langerhans cells in epithelium are presenting an antigen which activate the immune response, causes changes in epithelium
- LP does not have a single cause, but a final common pathway and taken attention to T lymphocytes
- Hep C/ Herpes virus pt may cause LP to become something much more serious
- external triggers may cause lichenoid change, ie: medicines anti-hypertensive, amalgam
9
Q
Cause of LP
A
- genetic
- physical and emotional stress
- injury to skin-> isomorphic response
- localised skin disease -> herpes zoster
- systemic viral infection, ie: Hep C, modify self antigens on surface of basal keratinocytes
- contact allergy. ie: amalgam
- drugs: gold, quinone, B-blockers, ACE inhibitors can cause lichenoid rash
10
Q
LP may affect skin and other body parts
A
- hair loss
- ridging on nails
11
Q
Symptoms of LP
A
- usually none
- sensitive to hot/spicy due to thinning of epithelium
- burning sensation in mucosa
- can normally involve other areas of body, ie: skin, scalp, genital, hand and nails
12
Q
OLP sites
A
- BM -MOST COMMON
- Gingivae (desquamative gingivitis)
- tongue - lateral and dorsum region
- lips
- palate
13
Q
Buccal LP
A
- commonest site
- anterior of commissure
(corner of the mouth, where the vermillion border of the superior labium (upper lip) meets that of the inferior labium (lower lip) - posterior around 3rd molars
** easier biopsy site
14
Q
Gingival LP
A
- isolation type
- desquamative gingivitis
- may have similar clinical appearance to gingival pemphigoid and plasma cell gingivitis (differentiate through histology)
- may be very erythematous and concerning to pt as it may be gum disease and lead to mobility of teeth
- reassure pt that GLP does not affect bone and no teeth should be lost
15
Q
Extra info on GLP
A
- may look patchy
- reticular pattern
- Good oral hygiene for dealing with lesion
- plaque driven in many patients
16
Q
Why is biopsy difficult for gingival lesions?
A
- risks of damaging gingival attachment area
- damage of adherent attached mucosa when lifting from bone
17
Q
Gingival Lichen Planus
A
18
Q
Tongue LP
A
- usually affecting dorsum and lateral region
- dorsum usually idiopathic
- loss of papillae and smooth tongue surface
- lateral aspect with drug/amalgam trigger
- look at tongue position at rest to see if there is amalgam contact
** May be easy to biopsy but painful healing
19
Q
Lip LP
A
- difficult to manage
- unsure then biopsy
- regular use of sunblock plus topical medicament for lichenoid change
20
Q
A
Dorsum of tongue
- dense, thickening
- hyperkeratosis present
Lateral aspect
- white hyperkeratotic change
- thickening of keratin
- ulcerative area maybe in contact with amalgam
