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4th year > OM-Lichen planus > Flashcards

OM-Lichen planus Flashcards

1
Q

Name the 3 types of lichen planus?

A

Reticular
Atrophic (subtype)
Erosive. (subtype)

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2
Q

Name & describe this type of lichen planus?

A

Reticular- lacey patterns of white lines running across the mucosa.

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3
Q

Name this type of lichen planus

A

Atrophic- an erythematous change to the mucosa.

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4
Q

Name this type of lichen planus?

A

Erosive- Atrophy extends to the point of having no epithelium at all. There is a yellowy fibrous covering over the base of the connective tissue.

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5
Q

What are the commonly seen histological features of lichen planus

A
  • Chronic inflammatory cell infiltrate (lymphocytic band hugging the basement membrane)
  • Saw tooth rete ridges.
  • Basal cell damage
  • Patchy acanthosis
  • Parakeratosis.
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6
Q

What causes lichen planus?

A

It is the final common pathway from the immune response after many different triggers.

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7
Q

What is a lichenoid reaction?

A

When the cause of the oral lesion is known.

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8
Q

What are the symptoms for lichen planus?

A

Often none
Sensitivity to hot/ spicy food
Burning sensation

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9
Q

On what sites do you find lichen planus?

A

Buccal mucosa.
Gingivae
Tongue (Lateral aspect/dorsum)
Lips
Palate

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10
Q

What is desquamative gingivitis ?

A

If the lichen planus lesion is only found on the gingivae

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11
Q

What is the most common site for lichen planus?

A

Buccal mucosa.

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12
Q

Describe the appearance of gingival lichen planus?

A

Erythematous gingivae.
No swelling in the gingival margins
Can be a simple reticular pattern

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13
Q

How does lichen planus present on the dorsum of the tongue?

A

Loss of papillae & smooth tongue surfaces.

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14
Q

What is the normal cause of lichen planus on the dorsum of the tongue?

A

normally idiopathic

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15
Q

What is the most likely cause of lichen planus on the lateral aspect of the tongue?

A

Drug/Amalgam trigger

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16
Q

What is characteristic of a lichen planus reaction to drugs?

A

Widespread.
Often bilateral and mirrored (Same lesion on L and R)
Often poorly responsive to standard steroid treatment.

17
Q

What medications commonly cause lichenoid reactions?

A

ACE inhibitors
Beta-adrenergic blockers
Diuretics (e.g. bendroflumethiazide/ Frusemide)
NSAIDs
DMARDs

18
Q

In what situations would it be beneficial to stop the patient’s drugs to remove the lichen planus?

A

If the lichen planus has significant symptoms requiring maximum topical or systemic treatment

19
Q

What is the best way to check if an amalgam restoration is causing the lichen planus?

A

Get the patient to occlude together and check the proximity of the lesion to the restoration

20
Q

What are the treatment options for lichen planus caused by an amalgam restoration?

A

Leave (if lichen planus is asymptomatic)
Replace amalgam restoration with a composite.

21
Q

What tests do we do if the cause of the lichen planus is not clear?

A

Biopsy
Haematinics
FBC
Lupus antibody test.

22
Q

How do we manage lichen planus in patients with mild symptoms?

A

0.2% Chlorohexidine mouthwash
Benzdamine mouthwash
Avoid SLS toothpaste.

23
Q

How do we manage patients with persisting symptomatic lichen panus lesions?

A

Beclomethasone MDI 0.5mg/puff - 2 puffs 2-3xdaily.
Betamethasone rinse- 1mg/10ml/2 mins/ twice daily.

24
Q

How is lichen planus managed in hospital?

A

Higher strength topical steroids (clobetasol)
Topical tacrolimus.
Hydroxychloroquine.
Systemic immunomodulators (Azathioprine/Mycophenolate)

25
Q

What can we use to help with the treatment of gingival lichen planus?

A

A gingival veneer to hold the topical steroid gel (Sinylar) in contact with the gums.

26
Q

Name 2 other conditions that look like lichen planus?

A

Lupus erythematosis
Graft verus host disease

27
Q

What is graft versus host disease and how does the histology compare to lichen planus?

A

This is commonly found in patients with stem cell or bone marrow transplants
The histology is very similar to lichen planus.

28
Q

What is Lupus Erythematosis and how does the histology compare to lichen planus?

A

This is a host immune system disease.
The histology- the inflammatory infiltrate is much further away from the basement membrane than that in lichen planus.

29
Q

When are atrophic and erosive lichen planus accepted as subtypes

A

When there are reticular lesions elsewhere in the mouth

30
Q

How do we distinguish between lichen planus and a lichenoid lesion

A

Lichen planus meets all the clinical and histopathological criteria.

Oral lichenoid lesion- may be compatable (resembles it) but not meet the criteria

31
Q

What are the clinical criteria for lichen planus?

A

presence of bilateral symmetrical lesions
Presence of a lace-like network of slightly raised gray-white lines (Reticular pattern)

Erosive or atrophic are only accepted if there are reticular lesions elsewhere

32
Q

What are the histopathological criteria for lichen planus?

A

Presence of a well defined bandlike zone of cellular infiltration that is confined to the superficial part of the connective tissues- consisting mainly of lymphocytes.
Signs of liquefaction degneration in the basal cell layer.
Absense of epithelial dysplasia

If the histopathologic features are less obvious we say it is histopathologically compatable.

33
Q

How does a biopsy showing keratosis of unknown significance affect our treatment?

A

We don’t discharge the patient as it could become a problem in the future

34
Q

How can oral lichenoid lesions be classified?

A

Amalagam restoratation topographically associated OLL
Drug related OLL
OLL in chronic graft versus host disease
OLL unclassified (none of the above/ not meeting all the LP classifications.

35
Q

What drives the cancer development from lichen planus?

A

Inflammation.

36
Q

Discuss risks of replacing an amaglam restoration to treat Lichen planus

A

 Replacement may not improve the reaction
 Removing the existing restoration could damage the tooth (Deep restoration/pulpal exposure)

37
Q

What is the risk of not replacing an amalgam restoration causing a lichenoid reaction ?

A

1% chance of malignant change- this can be monitored through clinical images.

We are more concerned about this risk in high risk patients (smokers/ smokers & drinkers)

4th year (51 decks)

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