Lichen Planus Overview Flashcards
What is Lichen Planus?
- chronic oral disease
- affects 1% of population
- age range 30-50 y/o
- idiopathic or drug related
What are the different clinical presentations of lichen planus?
- Reticular = lacy pattern of white lines running across mucosa
- Atrophy/Erosive = yellowish fibrous covering over base of connective tissue
how does lichen planus present histologically?
- chronic inflammatory cell infiltrate
- saw tooth rete ridges
- basal cell damage
- patchy acanthosis of epithelial layer
- parakeratosis
What viruses are implicated in immune upregulation but NOT as a cause of lichen planus?
- hepatitis C
- herpes virus
what external triggers can cause lichen planus?
- medicines
- amalgam restorations
What are some potential causes of lichen planus?
- genetic predisposition
- physical & emotional stress
- injury to skin
- localised skin disease (herpes zoster)
- systemic viral infection
- contact allergy (amalgam)
- drugs
What drugs can cause lichen planus?
- gold
- quinine
- beta blockers
- ace inhibitors
where is cutaneous lichen planus typically seen?
- around the wrists (purple lesions)
- ridging of nails
What are the symptoms of lichen planus?
- often none
- sensitivity to hot/spicy food
- burning sensation in mucosa (due to thinning of epithelium)
Where are the common affected sites for oral lichen planus?
- buccal mucosa (MOST COMMON)
- gingivae
- tongue (lateral aspect, dorsum)
- lips
- palate
what are lichen planus lesions on the gingivae ONLY commonly referred to as?
desquemative gingivitis
Where on the buccal mucosa are lichen planus reactions commonly found?
- anteriror at commisure
- middle
- posterior around 3rd molar tooth
Why is it good if lesions present on the buccal mucosa?
easy biopsy site
what can desquemative gingivitis sometimes be mistaken for?
- gingival pemphigoid
- plasma cell gingivitis
How does desquamative gingivitis present?
very red erythematous appearance of gingivae (full length of gingiva, not marginal)
can desquamative gingivitis cause tooth loss?
NO
- it is a surface level condition and does not affect bone levels directly
How is gingival lichen planus managed?
- oral hygiene very important in settling lesion
how does lichen planus present on the dorsum of tongue? what usually causes it?
- loss of papillae and smooth tongue surface
- idiopathic
what can be the cause of lichen planus on the lateral aspect of the tongue?
drugs or amalgam trigger
how might you tell if lichen planus on the lateral aspect of the tongue is caused by amalgam?
look at tongue position at rest, see if there is amalgam contact
why is the tongue not always the best place to biopsy?
very painful when healing
What medications are commonly associated with lichen planus?
- ACE inhibitors
- beta-blockers
- diuretics (frusemide)
- NSAIDs
- DMARDs
What medications are associated with lichen planus but more rarely?
- phenothiazines
what DMARDs are commonly associated with lichen planus?
- penicillamine
- gold
- sulphasalazine
