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BDS4 > Lichen planus > Flashcards

Lichen planus Flashcards

1
Q

What is lichen planus?

A

A chronic inflammatory immune mediated disease that affects the oral mucosa and skin

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2
Q

What is the most histological signs that is considered to be a diagnostic feature of lichen planus?

A

T-cell infilitrate into the basement membrane under the epidermis?

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3
Q

Other than a hugging band of lymphocytes at the basement membrane, Give 3 other histological signs of lichen planus?

A
  • Orthokeratosis
  • Civatte bodies
  • Vacuoles at basal layer
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4
Q

What is the aetiology of lichen planus?

A
  • Langerhans cells present an antigen that activates an immune response leading to t-cells attacking the body tissue
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5
Q

What are 4 triggers of lichen planus other than allergy to metals and drugs?

A
  • Genetics
  • Physical and emotional stress
  • Injury to the skin
  • Viral infections - herpes zoster and Hep C
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6
Q

If lichen planus occurs as a response of an injury to skin, what do we call this response?

A

isomorphic

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7
Q

If lichen planus occurs as a response of a localised skin disease such as herpes zoster, what do we call this response?

A

isotopic

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8
Q

What 2 group of drugs might trigger lichen planus?

A
  • beta-blockers
  • Ace inhibitors
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9
Q

What are the symptoms of lichen planus ?

A
  • Often none
  • sensitivity to hot and spice food
  • Burning sensation in the mucosa
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10
Q

Other than the oral mucosa , give 4 areas which can be affected by lichen planus?

A
  • Skin
  • Scalp
  • Genitals
  • Hair and nails
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11
Q

What 4 sites in the oral mucosa that can be affected by lichen planus?

A
  • buccal mucosa
  • gingivae
  • tongue
  • lips
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12
Q

What is the commonest site for lichen planus in the oral mucosa?

A

buccal mucosa - at commissure , middle , around 3rd molar

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13
Q

What term can describe gingival lichen planus?

A

Desquamative gingivitis

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14
Q

If lichen planus affect the dorsum of the tongue, what might your clinical findings be? 2

A
  • Loss of papilla
  • Smooth tongue surface
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15
Q

If the lateral aspect of the tongue is affected by lichen planus by an isolated lesion, what might be the trigger?

A

Amalgam

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16
Q

If there was a lichen planus lesion due to an amalgam restoration , what do we call it ?

A

Lichenoid reaction to amalgam

17
Q

3 main contributing factors to oral lichen planus ?

A
  • Idiopathic
  • Medication
  • Amalgam
18
Q

Other than beta-adrenergic blockers and ace inhibitors, give 3 groups of drugs that might cause a lichenoid reaction?

A
  • Diuretics - fruseamide
  • NSAIDs
  • DMARDs
19
Q

What 3 DMARDs that might cause lichenoid reaction?

A
  • penicillamine
  • Gold
  • Sulphasalazine
20
Q

Give 3 characteristics of lichenoid drug reactions?

A
  • more widespread lesions
  • often bilateral and mirrored
  • poorly responsive to standard steroid treatment
21
Q

When would you discuss changing medications if it is causing lichenoid reaction?

A

If it causes the patient severe symptoms

22
Q

A patient takes ACE inhibitors and it is causing a lichenoid reaction, to which drug would you change this?

A

AT2 blocker

23
Q

What would you do to an amalgam restoration if it is causing lichen planus?

A

Change the restoration, avoid during pregnancy

24
Q

What 2 special investigation would you want to take for a patient presenting with oral lichen planus ?

A
  • Biopsy
  • Blood tests : FBC and haematinics
25
Q

If you suspect lupus in a patient with oral lichen planus , what further investigation would you want to do?

A

Autoantibody screen for ( Ro, ANA, dsDNA)

26
Q

First step in managing lichen planus?

A
  • First remove cause if possible (restorations, medicines)
27
Q

What would you prescribe to a patient with mild LP lesion? and what advice would you give?

A
  • Chlorhexidine MW
  • Benzydamine MW
  • Avoid SLS containing toothpaste
28
Q

What would you prescribe for a LP patient with persisting symptomatic lesions in primary care setting?

A

Topical steroids such as
* beclomethasone inhaler
* betamethasone rinse

29
Q

What steroid treatment would be prescribed to a patient with persisting symptomatic lesions of LP in the hospital setting? 3

A
  • High strength topical steroids - clobetasol
  • Topical tacrolimus
  • Hydroxychloroquine
30
Q

What two systemic immunomodulators that can be prescribed to a patient with symptomatic LP?

A
  • Azathioprine
  • Mycophenolate
31
Q

A patient present with gingival lichen planus, how would you advice the patient to use when applying clobetasol?

A

Use gingival veneer

32
Q

What 2 systemic conditions can produce Oral lichen planus like lesions?

A
  • Graft versus host disease
  • Lupus erythematosus - especially on the palate
33
Q

How would lichen-like lesions in Lupus erythematosis be different from oral lichen planus histologically?

A

In SLE the lymphocytic infiltrate is deeper in the connective tissue away from the basement membrane

BDS4 (63 decks)

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