Lichen Planus

Question 1

What is lichen planus?

Answer 1

Cytotoxic T cell mediated basal keratinocyte destruction

Question 2

Describe the different types of lichen planus?

Answer 2

Reticular - white lace pattern
Atrophic - inflamed areas, with thinned red epithelium
Bulbous - blistered appearance with ulceration
Erosive - atrophic appearance with ulceration
Plaque-like - white plaques
Papular - small white papules

Question 3

Who in the population is affected by lichen planus?

Answer 3

0.5-2%
Female > male
Typically over age 40

Question 4

What is the difference between lichen planus and a lichenoid lesion?

Answer 4

Lichen planus is idiopathic
Lichenoid lesion looks like lichen planus but has a cause

Question 5

Where else is affected by lichen planus?

Answer 5

Skin and genitals

Question 6

What is the malignancy rate of lichen planus?

Answer 6

1% over 10 years risk of malignant change

Question 7

What drugs cause OLRs?

Answer 7

Antihypertensives
Antimalarials
NSAIDs
Allopurinol
Lithium

Question 8

Which materials cause OLRs?

Answer 8

Metals - gold, nickel
Maybe amalgam

Question 9

Which diseases can cause OLRs?

Answer 9

Recent cancer therapy
Lupus
GVHD

Question 10

How is oral lichen planus managed?

Answer 10

Warm salty mouthwash
LA - benzydamine or lidocaine
Avoid trigger factors - spicy foods or fizzy drinks
Steroid mouthwash - betamethasone mouthwash, beclometasome inhaler or hydrocortisone oromucosal tablets
Change amalgam restorations to composite
Referral to OM - biopsy
If managing in practice review regularly
Inform of increased cancer risk but put in context that risk is low