Managing Lichen Planus

Question 1

what are the contributing factors to Lichen planus?

Answer 1

Most idiopathic
Some related to medication
some related to amalgam restorations
some related to patients with Hep C

Question 2

what medications are used to manage lichen planus?

Answer 2

• Topical corticosteroids
• Ace inhibitors
• Beta-adrenergic blockers
• Diuretics - furosemide
• NSAIDs
• DMARDs (disease modifying antirheumatic drugs)

Question 3

when do you call it lichenoid reaction to.. vs oral lichen planus?

Answer 3

its called a lichenoid reaction when you know what the trigger of it is.

Question 4

when managing lichenoid drug reactions/side effects, what do you need to weigh up with the patient?

Answer 4

• benefit of drug
• risk of stopping drug
• discomfort from symptoms

Question 5

how do you manage an amalgam related lesion?

Answer 5

if NOT symptomatic, check for malignancy, maybe change amalgam.

if SYMPTOMATIC - replace amalgam (Composite, GI, Gold alloy)

Question 6

what the overall lichen planus management?

Answer 6

Remove any cause:
- meds
- dental restorations

Biopsy:
- unless good reason not to

Blood Tests:
- haematinics
- FBC
- if lupus suspected, antibody screen too

Question 7

if lichenoid lesions are mild & intermittent, what advice can you give?

Answer 7

Topic OTC remedies,
Chlorhexidine MW
Benzydamine MW (NSAID)

Avoid SLS Toothpaste

Question 8

how do you manage a PERSISTENT symptomatic lesion of Lichen planus?

[primary care]
&
[hospital setting]

Answer 8

[Primary Setting]
- Topical Steroids
Beclomethasone inhaler
Betamethasone MW

[Hospital Setting]
- Increased strength topical steroids,
- Systemic immunomodulators
- Hydroxychloroquine (antirheumatic drug)

Question 9

what are some lichen like lesions?

Answer 9

• Graft vs host disease
• Lupus lesions