Management of Lichen Planus Flashcards
Which medications can be responsible for causing Lichen Planus?
Common:
ACE inhibitors
Beta-adrenergic blockers
Diuretics – Bendroflumethiazide, frusemide
NSAIDs
DMARDs (anti-thematics)- sulphasalazine
Rare:
phenothiazines
What are the features of lichenoid drug reactions?
More often widespread lesions
Often bilateral and mirrored
Often poorly responsive to standard steroid treatment
What should be considered when altering medication due to lichenoid drug reactions?
Risk/benefit analysis- does the benefit of stopping the medical drug outweigh the risk to the patient’s health (discuss with patient’s GP)
-> Mild lichen symptoms – unlikely
-> Significant lichen symptoms – probably
(Where maximum topical or systemic treatment likely needed to control the lichen symptoms)
What can be used instead of ACE inhibitors if they are causing drug related lichenoid reactions?
AT2 blockers
-> have same effect on BP
What aspects of amalgam could be the cause of LP?
Mercury
Corrosive products
What can be done to manage amalgam related LP?
Replace amalgam with adhesive restorative material (not always possible)
Patch tests for amalgam and mercury sensitivity
What are the DIS of replacing amalgam filling thought to be triggering LP?
Increased damage to tooth tissue
Cost for adhesive restorations- although patient only has to pay price of new amalgam
What are the ADV of replacing amalgam fillings thought to be causing LP
LP is a potentially malignant lesion- reduces risk of malignant change
Other amalgams don’t need to be replaced unless they are in direct contact to lichenoid lesions
What are examples of materials used to replace amalgam causing lichenoid reactions?
Composite
Glass
Gold – low Palladium Alloy (PMA)
-> may also cause lichenoid reactions
Bonded crown
Why must we be careful when removing amalgam? What equipment is required?
As mercury vapour can be released and cause health issues
Use- Rubber dam, High volume suction, PPI to reduce risk
When should amalgam removal be totally avoided?
In pregnancy
How is LP managed generally?
Remove any cause:
-> Medicines
-> Dental restorations
BIOPSY
Blood tests
-> Haematinincs
-> FBC
-> If lupus suspected autoantibody screen (ANA, Ro, dsDNA)
How are mild intermittent lichenoid lesions treated?
Topical OTC remedies
-> Chlorhexidene m/w
-> Benzdamine m/w
Avoid SLS containing toothpaste
-> replace with Sensodyne Pronamel and Kingfisher
What can be used to treat persisting symptomatic lesions in primary care setting?
Topical steroids (as for Oral Ulcers)
-> Beclomethasone MDI 0.5mg/puff – 2 puffs x 2-3 daily
-> Betamethasone rinse – 1mg/10ml/2mins/twice daily
What can be used to treat persisting symptomatic lesions in hospital setting?
Higher strength topical steroids – puffer or rinse
‘Skin’ Steroid Cream – CLOBETASOL
-> Cream can be applied in a ‘veneer’ for gingival lesions
Topical tacrolimus – ointment or mouthwash
Hydroxychloroquine- good for cutaneous and oral
Systemic immunmodulators
-> Azathioprine
-> Mycophenolate
