OM- Lichen Planus Flashcards
Lichen planus histology
Chronic inflammatory cell infiltrate
Saw tooth rete ridges
Basal cell damage
Patchy acanthosis
Parakeratosis
Lichen planus aetiology
Genetics
Stress
Localised skin disease- herpes zoster
Systemic viral infection- hep C
Allergy/drugs(beta blocker)
Amalgam
GVHD
Oral lichen planus commonest sites
Buccal mucosa
Gingivae
Tongue dorsum+lateral aspect
Lips
Palate
What concerns do pt have with gingival LP?
That it’s gingivitis and teeth will fall out
Management of gingival lichen planus
Reassurance that not same as gingivitis
OHI
biopsy- avoid unless necessary as risk of damaging attachment area
Medications which might cause LP
Ace inhibitors
Beta adrenergic blockers
DMARDs
NSAIDs
How can u tell if lichen planus caused by drug reaction
Widespread lesion
Bilateral
Mirrored
Poorly responsive to standard steroid tx
Lichenoid drug reaction management
Risk benefit of using drug vs stopping
Mild- unlikely
Severe- discuss alternative medication with GP
Lichen planus initial management
Biopsy- perilesional incisional
Blood test- haematinics, FBC, suspected SLE=autoantibody screen(ANA,Ro,dsDNA)
Remove cause- medicines,amalgams
Lichen planus mild intermittent lesion management
Avoid SLS containing toothpaste
CHX MW
Benzdamine MW
Lichen planus persisting symptomatic lesion management
Primary care:
Beclomethasone MDI 0.5 mg/puff 2/3x daily
Betamethasone rinse 1mg 2xdaily
Secondary care:
Clobetasol- skin steroid cream- can be applied in veneer for gingival lesion
Immune modulation (azathioprine,mycophenolate)
Topical tacrolimus
Hydroxychloroquine
Graft versus host disease (GVHD) aetiology
New transplanted bone marrow recognises new host as foreign- rejects host
GVHD presentation/ histology
Lichenoid reactions in mouth
Histology- same as LP
