Lichen Planus

Question 1

What is Lichen Planus?

Answer 1

A common condition affecting around 1% of the population involving skin and mucous membranes

Question 2

Lichen Planus peak incidence

Answer 2

3rd to 6th decades
60% female

Question 3

Lichen Planus clinical fetaures

Answer 3

oral lesions
- bilateral
- affect buccal mucosa and lateral aspects of the tongue
- gingivae may show red atrophic appearance - desquamative gingivitis
- palate usually spared

Question 4

What are the 3 clinical variants of oral lichen planus?

Answer 4

non erosive type
- most common, usually asymptomatic
minor erosive type
- areas of redness and superficial ulceration
major erosive type
- atrophy, redness and extensive ulceration

Question 5

Lichen Planus - give the variants of oral lesions

Answer 5

Reticular
- net-like pattern or linear white bands
plaque
- white patches
papular
- multiple white papules/spots which may join up
atrophic lesions
- diffuse red areas/red mucosa
- due to thinning of mucous membrane
erosive
- extreme atrophy leading to ulceration
bullous
- blood filled blisters, rare

Question 6

Lichen planus histopathological features

Answer 6

epithelium varies in thickness and may show areas of keratosis or atrophy
sub epithelial band of T lymphocytes and histiocytes
T cells cross basement membrane into epithelium
Basal cell degeneration

Question 7

Lichen Planus oral cancer risk

Answer 7

1% over 10 years

Question 8

Lichen Planus management

Answer 8

aim to alleviate symptoms (consider specialist opinion)
- betamethasone mouthwash
- beclomethasone inhaler sprayed onto affected area
- hydrocortisone lozenges
- Benzydamine mouthwash

diet modification
- avoiding spicy foods
- SLS free toothpaste

Question 9

Lichenoid reaction management

Answer 9

changing medication responsible
replacing amalgam restorations
- if lesion is in close proximity to restoration