Mx of Lichen Planus

Question 1

55-year old presents in general practice w/ sore mouth and recent appearance of multiple white areas. What is differential diagnosis?

Answer 1

Oral lichen planus
Leukoplakia
SCC
OLR
Discord/ systemic lupus

Question 2

What is classical appearance of OLP?

Answer 2

Diffuse white Lacey lesion, buccal mucosa
Can appear as different types: plaque, reticular etc

Question 3

What drugs are reported w/ OLR?

Answer 3

Amalgam
Allopurinol
Chloroquine antimalerials
Beta blockers
NSAIDs
Oral hypoglycaemia
Angiotensin-convering enzyme inhibitors

Question 4

What are 6 types of OLP?

Answer 4

Reticular
popular
Plaque
Atrophic
Erosive
Bullous

Question 5

What is initial mx of OLP in practice?

Answer 5

Explanation
Symptom control - topical anaestehtic/ difflam
Identification of cause - drugs/ amalgam removal
Referral to secondary care

Question 6

What other advice can give pt who have suspected OLP?

Answer 6

Use of SLS free toothpaste
Avoid exacerbating factors - spicy food/ smoking

Question 7

How it OLP diagnosed?

Answer 7

Incisional biopsy
Microbiological swab
Haematology

Question 8

Why are swabs taken in OLP?

Answer 8

Symptoms can be caused by superficial candidal infection

Question 9

What are histological characteristics of OLP?

Answer 9

Hyperkeratosis
Degradation of basement membrane
Destruction of basal cells
Dense band of lymphocitic/ inflammatory infiltrate
Absence of dysplasia

Question 10

What is often prescribed to pt w/ OLP?

Answer 10

Prednisolone mouth rinse or bethamethasone mouth rise