Lichen Planus and Lichenoid Reactions Flashcards
How can LP affect the nails?
Can cause longitudinal grooving and pitting (normally reversible)
Or lose the nail entirely
Which of the 7 LP variants is a lichenoid reaction most likely to present as?
Likely to be erosive form
What variant of oral LP is this?
Erosive (ulcerative)
Which ethnicities are more affected by oral LP?
Europeans and Indians
What variant of oral LP is this?
Erythematous (atrophic)
What ages are most commonly affected by oral LP?
40-80
What is the malignancy chance of Oral LP?
Variable transformation rate ~ 0.5-2%
What is oral lichen planus?
A chronic inflammatory condition that affects mucous membranes inside your mouth
This condition is pre-malignant
What is the best diagnostic tool for drug induced lichenoid reaction?
Removal of the drug
If a patient has skin LP what is the likelihood they have oral LP?
And Vice versa?
70 - 77% of skin LP patients have oral lesions
10 - 30 % of oral LP patients have skin lesions
How do you manage a lichenoid reaction?
Careful drug history needs to be taken and time relationship with appearance of lesions established
May consider patch testing if local causes
Resolution of the lesions should occur on withdrawal of drug
What type of drugs can induce a lichenoid reaction?
What other specific drugs outside those categories can induce a lichenoid reaction?
- Beta-blockers (E.g. Propranolol, Atenolol)
- ACE Inhibitors (E.g. Captopril & Enalapril)
- Diuretics (E.g. Furosemide, Indapamine, Mannitol)
- NSAIDs (E.g. Aspirin & Ibuprofen)
- Anti-malarial
- Oral Hypoglycaemics
Specific drugs
- Penicillamine (Rheumatoid Arthritis treatment)
- Allopurinol (Gout treatment)
- Gold Salts (Rheumatoid Arthritis treatment)
- Methyldopa (Hypertension treatment)
Where are extra-oral LP lesions of the skin commonly found?
Symmetrical distribution, usually on flexor surfaces of wrists/shins or sites of trauma
Koebner phenomenon
What systemic corticosteroids can be used to treat oral LP?
Prednisolone
Deflazacort
What Topical Calcineurin Inhibitors can be used to treat oral LP?
Ciclosporin
Tacrolimus
Pimecrolimus
What histopatholgical features would you expect to see with LP?
- Subepithelial band of inflammatory cells
- Basal cell liquefaction (Destruction of basement membrane)
- Hyperkeratosis
Pic 1 = 1 / Pic 2 = 2
What is Koebner phenomenon?
Where LP lesions often in increased friction or trauma area
How do you treat asymptomatic oral LP?
- Reassure patient & review
- Pt should be informed of malignant risk & encouraged to attend regularly
- Pt should be made aware lesions may develop outside of the mouth
- Advised to maintain good OH and Smoking/drinking cessation
NO CURE Just aim to reduce pain & inflammation and prevent complications
What are the differences in duration for oral and skin presentations of LP?
Oral - range 4 - 25 years, mean 7 years
Skin - 18 months on average
What dental materials can induce a lichenoid reaction?
- Metallic restorative materials (E.g. Gold/Amalgam/Nickel)
- Resins (Bis-GMA)
Describe how skin LP lesions look
Red papules that turn purple, flat and polygonal in shape
Surface network of fine white striations (Wickham’s striae)
What is the difference between a lichenoid reaction and LP?
A lichenoid reaction is similar in clinical presentation & histology to LP but has a more defined aetiology:
* Drug-induced or Dental material related
What variant of oral LP is this?
Papular
Which gender is more affected by oral LP?
60% Females
What topical corticosteroids can be used to treat oral LP? (3)
Hydrocortisone
Betamethasone
Benzydamine (difflam)
What are the 7 morphological variants of Oral LP lesions?
Erythematous (Atrophic)
Erosive (Ulcerative)
Plaque-like
Reticular
Bullous
Circinate
Papular
What is the first line therapy for LP?
Topical corticosteroids
What sites in the mouth have a higher presentation of oral LP?
Lesions often in increased friction or trauma area (Koebner phenomenon)
What variant of oral LP is this?
Plaque-like
How do you treat symptomatic oral LP?
- Eliminate provoking factors of mechanical trauma
- Reduce chemical irritation (spicy/acidic food & SLS-free toothpaste in desquamative gingivitis)
- Good OH & CHX mouthwash & smoking/drinking cessation
NO CURE Just aim to reduce pain & inflammation and prevent complications
Are Oral LP lesions commonly unilateral or bilateral?
Lesions are commonly bilateral (mirrored)
The aetiology of Lichen Planus is unknown, what are some proposed theories?
Maybe Autoimmune (cytotoxic T cells)
OR
Related to stress, spicy foods, diabetes or liver disease
How can LP affect the hair?
Can cause permanent scarring leading to alopecia
What variant of oral LP is this?
Reticular
What variant of oral LP is this?
Circinate
Where are extra-oral LP lesions of the skin commonly found?
Symmetrical distribution, usually on flexor surfaces of wrists/shins or sites of trauma
Koebner phenomenon
What is a very important piece of information you have to tell a patient with LP?
Patients should be informed of the risk of malignant transformation
