Lichen Planus Overview

Question 1

What is lichen planus?

Answer 1

a chronic inflammatory condition affecting mucous membranes of the oral cavity

Question 2

what can be the cause of lichen planus?

Answer 2

can be idiopathic or drug related

Question 3

what are the types of oral lichen planus

Answer 3

Reticular (white lacy patches)
Atrophic/erosive
Ulcerative

Question 4

what are the histopathological signs of lichen planus/lichenoid reaction?

Answer 4

• Chronic inflammatory cell infiltrate
• Saw tooth rete ridges (extension of epithelium increasing surface area for adhesion)
• Basal cell damage
• Patchy acanthosis
• Parakeratosis

Question 5

What viruses present in a patient can upregulate the immune response in Lichen planus?

Answer 5

Hepatitis C, Herpes Virus

Question 6

What are some external triggers for a lichenoid reaction?

Answer 6

Some medications, AMALGAM restorations

Question 7

whats thought to be the general causes of lichen planus

Answer 7

Genetic predisposition
physical & emotional stress
Injury to skin
Localised skin disease such as herpes zoster
Systemic viral infection (Hep C - modifying immune response)
- Contact allergy, such as amalgam fillings
- Drugs; ace inhibitors, b-blockers, quinine (anti malaria drug)

Question 8

what are the general symptoms of lichen planus?

Answer 8

Usually none
Some symptoms relating to thinning of epithelium (sensitive to hot/spicy food, burning sensation in mucosa)

Question 9

what other parts of the body can be included if a patient has lichen planus?

Answer 9

Skin, scalp, genitals, hair & nails

Question 10

where are the main sites in the oral cavity that could experience lichen planus?

Answer 10

buccal mucosa
gingiva (desquamative gingivitis)
tongue - lateral aspect, dorsal
lips
palate

Question 11

what is reticular lichen planus?

Answer 11

net like/spider web appearance on mucosa

Question 12

what is gingival lichen planus?

Answer 12

Often termed desquamative gingivitis

Very erythematous appearance on gingivae

can be very patchy/more typical reticular pattern seen

Keeping good OH is very important to control it

hard to biopsy without damaging gingivae

Question 13

what is tongue lichen planus?

Answer 13

dorsum - usually idiopathic (loss of papillae & smooth tongue surface)

lateral - may be amalgam induced, check position at rest

Easy biopsy site