OLP

Question 1

what is OLP

Answer 1

common, chronic, immune mediated mucotaneous disease

affects oral mucosa, skin, nails, scalp, anogenital, pharynx, oesophagus, conjunctive

Question 2

epidemiology and genetics involved in OLP

Answer 2

1%, 30-65, female

HLA B15, B5, B7
genes encoded in chromosome 6

Question 3

describe the immunopathogenesis of OLP

Answer 3

adaptive immune response
CD8+ T CELL MEDIATED DESTRUCTION OF BASAL KERATINOCYTES

CD8+ cells recognise antigen on basal keratinocytes, release granzyme and perforin to disrupt cell membrane and cause death
release of pro-inflammatory cytokines

Question 4

risk factors/manifestations for OLP

Answer 4

stress, genetics, chronic trauma
medications
dental materials
viral infection
lupus, GVHD, hepatitis C
DM, hypertension, hyperthyroidism
SLS
autoimmune
nutritional deficiency

Question 5

describe what would be seen histologically in OLP

Answer 5

death of basal keratinocytes
band-like lymphocytic infiltrate
acanthoses
hyperparakeratosis
saw tooth rete pegs
higher CD8+ T cell frequency
epithelial atrophy/erosion

Question 6

name the 6 subtypes and describe them

Answer 6

reticular = net-like, lacy, asymptomatic

papular = papules

erosive/ulcerative = ulcers, persistent, symptomatic, high risk malignant

atrophic = red mucosa, desquamative gingivitis, thinning membrane

plaque-like = thickened plaque

bullous = bullae, exclude VB

Question 7

GDP management

Answer 7

photos, reassure, OHI, PMPR, change AM, SLS free, avoid triggers, educate

benzydamine 0.15% MW / spray
betamethasone 500mcg tabs in 10ml water, rinse 5mins, spit, 4x day
beclomethasone 50mcg inhaler - localised, 1-2 puffs 2x day

Question 8

when would you refer

Answer 8

symptomatic
non-reticular
unilateral/non-symmetrical
unclear diagnosis
risk factors for malignant change
biopsy indicated

Question 9

secondary care management

Answer 9

FBC, haematinics, oral rinse to exclude fungal, skin antibody to exclude blistering, patch tests, stop meds

systemic prednisolone
topical - clobetasol, flucinolone v splint
calcineurin inhibitors
hydrochloroquine
azathioprine

investigations of hep c, lupus, gvhd

Question 10

risk of malignant change

Answer 10

1% over 10 years

Question 11

adv and disadv of incisional biopsy

Answer 11

adv - confirms diagnosis, may identify dysplasia/risk of malignant change, excludes VB

disadv - pain, bleeding, swelling, altered sensation, infection, sutures

Question 12

how does OLTR appear

Answer 12

distribution around amalgam
starburst appearance