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BDS4 ORAL MEDICINE > Lichen Planus Overview > Flashcards

Lichen Planus Overview Flashcards

1
Q

What is Lichen Planus?

A
  • chronic oral disease
  • affects 1% of population
  • age range 30-50 y/o
  • idiopathic or drug related
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2
Q

What are the different clinical presentations of lichen planus?

A
  • Reticular = lacy pattern of white lines running across mucosa
  • Atrophy/Erosive = yellowish fibrous covering over base of connective tissue
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3
Q

how does lichen planus present histologically?

A
  • chronic inflammatory cell infiltrate
  • saw tooth rete ridges
  • basal cell damage
  • patchy acanthosis of epithelial layer
  • parakeratosis
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4
Q

What viruses are implicated in immune upregulation but NOT as a cause of lichen planus?

A
  • hepatitis C
  • herpes virus
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5
Q

what external triggers can cause lichen planus?

A
  • medicines
  • amalgam restorations
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6
Q

What are some potential causes of lichen planus?

A
  • genetic predisposition
  • physical & emotional stress
  • injury to skin
  • localised skin disease (herpes zoster)
  • systemic viral infection
  • contact allergy (amalgam)
  • drugs
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7
Q

What drugs can cause lichen planus?

A
  • gold
  • quinine
  • beta blockers
  • ace inhibitors
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8
Q

where is cutaneous lichen planus typically seen?

A
  • around the wrists (purple lesions)
  • ridging of nails
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9
Q

What are the symptoms of lichen planus?

A
  • often none
  • sensitivity to hot/spicy food
  • burning sensation in mucosa (due to thinning of epithelium)
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10
Q

Where are the common affected sites for oral lichen planus?

A
  • buccal mucosa (MOST COMMON)
  • gingivae
  • tongue (lateral aspect, dorsum)
  • lips
  • palate
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11
Q

what are lichen planus lesions on the gingivae ONLY commonly referred to as?

A

desquemative gingivitis

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12
Q

Where on the buccal mucosa are lichen planus reactions commonly found?

A
  • anteriror at commisure
  • middle
  • posterior around 3rd molar tooth
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13
Q

Why is it good if lesions present on the buccal mucosa?

A

easy biopsy site

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14
Q

what can desquemative gingivitis sometimes be mistaken for?

A
  • gingival pemphigoid
  • plasma cell gingivitis
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15
Q

How does desquamative gingivitis present?

A

very red erythematous appearance of gingivae (full length of gingiva, not marginal)

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16
Q

can desquamative gingivitis cause tooth loss?

A

NO
- it is a surface level condition and does not affect bone levels directly

17
Q

How is gingival lichen planus managed?

A
  • oral hygiene very important in settling lesion
18
Q

how does lichen planus present on the dorsum of tongue? what usually causes it?

A
  • loss of papillae and smooth tongue surface
  • idiopathic
19
Q

what can be the cause of lichen planus on the lateral aspect of the tongue?

A

drugs or amalgam trigger

20
Q

how might you tell if lichen planus on the lateral aspect of the tongue is caused by amalgam?

A

look at tongue position at rest, see if there is amalgam contact

21
Q

why is the tongue not always the best place to biopsy?

A

very painful when healing

22
Q

What medications are commonly associated with lichen planus?

A
  • ACE inhibitors
  • beta-blockers
  • diuretics (frusemide)
  • NSAIDs
  • DMARDs
23
Q

What medications are associated with lichen planus but more rarely?

A
  • phenothiazines
24
Q

what DMARDs are commonly associated with lichen planus?

A
  • penicillamine
  • gold
  • sulphasalazine
25
Q

how do lichenoid drug reactions typically present?

A
  • often more WIDESPREAD
  • often BILATERAL and mirrored
  • often poorly responsive to standard steroid treatment
26
Q

how are drug lichenoid reactions managed?

A
  • benefit of drug vs risk of stopping drug
  • dependant on discomfort from symptoms (mild = discomfort … severe = probably)
27
Q

how are amalgam lichenoid related lesions managed?

A
  • potentially replace restoration with alternative material (composite)
  • if non-symptomatic sometimes do nothing
28
Q

what blood tests are done when patients show with lichen planus?

A
  • haematinics
  • FBC
  • if lupus is suspected do an autoantibody screen (ANA, Ro, DsDNA)
29
Q

what dental related management options are there to help with mild lichen planus?

A
  • OHI
  • chlorhexidine mouthwash
  • benzdamine mouthwash
  • avoid SLS containing toothpaste
30
Q

what management options are there to help with more severe lichen planus in primary care settings?

A

Topical Steroids
- Beclomethasone MDI
- Betamethasone rinse

31
Q

What is the dose of Beclomethasone prescribed for severe lichen planus?

A

0.5mg puff, 2 puffs, 2/3 times daily

32
Q

What is the dose of Betamethasone prescribed for severe lichen planus?

A

1mg/10mls rinse for 2 mins, 2 times daily

33
Q

If primary care topical steroids do not help lichen planus, what are the other options?

A

Hospital Setting
- higher strength topical steroids (CLOBETASOL)
- topical tacrolimus
- hydroxychloroquine
- systemic immunomodulators

34
Q

What systemic immunomodulators may be prescribed in severe cases of lichen planus?

A
  • Azathioprine
  • Mycophenolate
35
Q

what other diseases can present very similarly to lichen planus?

A
  • graft versus host disease (systemic disease)
  • lupus erythematosis
36
Q
A

BDS4 ORAL MEDICINE (21 decks)

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