Managing Lichen Planus Flashcards
what are the common medications known to give a lichenoid reaction
ACE inhibitors
B adrenergic blockers
diuretics
NSAIDs
DMARDs
what DMARDs cause lichenoid reactions
penicillamine
gold
sulphasalazine
what does a lichenoid drug reaction look like
widespread lesions
bilateral and mirrored
how do you manage a lichenoid drug reaction
consider benefit of drug to risk of stopping it
improve discomfort from the symptoms
if you are unsure if someone is allergic to amalgam what would you do
patch skin test
how do you manage amalgam lichenoid reaction
if unsymptomatic do nothing
replace amalgam with composite
how do you manage lichen planus
remove any causes
biopsy
blood tests - haematinics, FBC, autoantibody screen
how do you treat mild intermittent lichen lesions
topical OTC remedies (chlorhexidine and benzydamine mouthwashes)
avoid SLS toothpaste
how do you treat a persisting symptomatic lichen lesion in primary care
topical steroids (beclomethasone MDI or betamethasone rinse)
how do you treat a persisting symptomatic lichen lesion in hospital
higher strength topical steroids
clobetasol skin steroid cream
topical tacrolimus
hydroxychloroquine
immunemodulators
what is graft versus host disease
transplant marrow recognises host as foreign and causes immunological damage to reject the host
looks similar to lichenoid reactions
what does graft versus host disease look like on histology
lymphocytic band along basement membrane and change in keratinisation and prickle cell layers
what does lupus erythematous look like on histology
intense lymphocytic infiltrate much deeper in connective tissue and away from basement membrane
why are lichen like reactions important
because underlying disease needs consideration
