Lichen Planus

Question 1

List the types of LP (6)

Answer 1

RAPBPE

Reticular
Atrophic
Papular
Bullous
Plaque
Erosive

Question 2

Histology of Lichenoid Reaction

Answer 2

T cell infiltrate
Saw tooth retention ridges
Patchy acanthosis
Basal cell damage
Parakeratosis

Question 3

Describe the histology of Lichen Planus

Answer 3

Lymphocytic band
Civatte bodies
Orthokeratosis
Wedge shaped hypergranulosis

Question 4

List the causes of LP

Answer 4

Immune reaction
Stress
Genetics
Injury to skin
Viral infection
Contact allergy w AMALGAM
Drugs - B blockers, Ace inhibitors, NSAIDs, diuretics

NOT AN INFECTION/NOT CONTAGIOUS

Question 5

Symptoms of LP

Answer 5

Often none
Burning/stinging in mouth when eating/drinking
Hot/spicy/citrus/alcohol

Question 6

Oral LP sites

Answer 6

Tongue
Lips
Palate
Gingivae
Buccal mucosa

Question 7

Features of lichenoid drug reactions

Answer 7

More widespread
Often bilateral + mirrored
Poor response to steroid tx

Question 8

Managing LP

Answer 8

Remove cause - if meds/amalgam restoration
Avoid AM removal during pregnancy
Biopsy
Bloods - haematinics, FBC, if lupus suspected autoantibody screen (ANA, Ro)

Question 9

Tx for LP

Answer 9

1. CHX MW
   Benzydamine MW -pain
   SLS Free TP/avoid hot/spicy
2. Topical steroids
   Beclomethasone inhaler, Betamethasone MW
3. Higher strength topical steroids
   Clobetasol skin cream, Tacrolimus, Hydroxylchloroquinone, Systemic immunomodulators - Azathioprine

Question 10

When is GVHD common?

Answer 10

Presents similar to lichenoid reactions
Common after stem cell transplants/BMT