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DS4101 > W7 - Lichen Planus - Thomson > Flashcards

W7 - Lichen Planus - Thomson Flashcards

1
Q

2 classifications of specific pattern white lesions that cannot be scraped off

A

Oral Lichenoid reactions

Lupus erythematous

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2
Q

What are 4 oral lichenoid reactions

A
  1. Oral Lichen planus
  2. Oral lichen planus associated with underlying disease (diabetes, hep c)
  3. Lichenoid contact reactions (LCR)
  4. Drug induced lichenoid reactions (DILR)
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3
Q
A

Lichen Planus

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4
Q
A

Oral lichenoid contact reaction

(notice proximity to amalgam)

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5
Q
A

Oral lichenoid reaction (contact)

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6
Q

What is lichen planus?

A

Chronic inflammatory disease affecting skin and mucous membrane

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7
Q

How does lichen planus appear clinically? (6)

A

“lace-like”

Papular

plaque-like

erosive

atrophic

bullous

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8
Q

How does lichen planus appear on the skin? (+location)

A

Violaceous, flat-topped papules

  • ankles
  • Wrists
  • genitalia

-Facial skin is spared

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9
Q

What is the Koebner phenomenon

A

The appearance of Whickham’s Striae (lace-like appearance) of lichen planus skin lesions

  • appears when you scrape across the skin
  • uncomfortable for patients
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10
Q
A

Whickham’s Striae

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11
Q
A

Lichen Planus appearing on skin

  • wrist
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12
Q
A

labial lichen planus

Rarely affected compared to oral mucosa

Can be confused with actinic cheilitis

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13
Q

What are the three types here

A

Papular

Reticular

Erosive-ulcerative

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14
Q

What type of LP

A

Erosive-ulcerative lingual LP

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15
Q

What is desquamative gingivitis?

How does it appear clinically?

A

Widespread erythematous gingiva

Blister formation

Desquamation and erosion of gingival epithelium

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16
Q
A

Desquamative gingivitis

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17
Q
A

Desquamative gingivitis

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18
Q

Common conditions that can lead to desquamative gingivitis (6)

A

Lichen planus

Mucous membrane pemphigoid

Bullous pemphigoid

Pemphigus vulgaris

Paraneoplastic pemphigus

Dermatitis hepetiformis

19
Q

Pathogenesis of Lichen Planus

A

T-cell mediated autoimmune disease

  • CD8 T-cells trigger apoptosis of basal keratinocytes in oral epithelium in response to unknown endogenous antigen or known exogenous antigen
20
Q

What virus may be an aetiological factor in OLP

A

Hep C (HCV)

21
Q

Essential Features for histopathological diagnosis of OLP (3)

A

Liequefaction Degeneration in basal cell layer (dead cells)

Well-defined band of T cells in superficial connective tissues

Absence of dysplasia

22
Q
A

Spaces - Liquefaction degeneration

Blue cells - T lymphocytes

Arrow - Civatte body (dead epithelial cell)

23
Q

Differential diagnoses of OLP

Exam question

A

Frictional keratosis

Oral lichenoid reaction

Leukoplakia

Lupus erythmatosus

Pemphigus

Mucus membrane pemphigoid

Erythematous candidiasis

24
Q

Pathognomonic clinical appearance of OLP

A

Interlacing white reticular striae on bilateral posterior buccal mucosa

25
How to differentiate OLP from lichenoid drug reaction
Drug reaction will be **unilateral** and accompanied by history of using a **new drug** * Diagnose by removing pt from drug observe the reaction resolve
26
What drugs can cause lichenoid drug reactions
“Anti-things” 1. Anti-hypertensives 2. Anti-inflammatory (NSAID) 3. Anti-diabetic 4. Anti-thyroid 5. Anti-malarials
27
How to differentiate OLP from vesiculo-bullous disorders (pemphigus, pemphigoid)
Pemphigus and pemphigoid are solitary erythematous lesions ## Footnote **no white striae**
28
How to differentiate lupus erythematosis from OLP
Could resemble erosive LP but will be less **symmetrically distributed** **-** LP has facial skin spared - Lupus' striae are more "delicate" and radiate from a central focus
29
Management of OLP
**Patient education** **Active patient monitoring** **Supportive measures** (elimination of provoking factors, minimize trauma to mucosa) **Supplemental measures** (CHX - diluted)
30
What does the pt need to be educated about regarding their OLP
* It's a chronic disorder - long term * No treatment availble * May require symptomatic relief
31
Therapeutic aims of LP management (4)
Minimize the immune-mediated inflammatory response Avoid opportunistic infections Keep it simple Empirical (based on observation)
32
Topical “treatments” of OLP (3)
CHX - diluted Orabase Kenalog
33
What is Orabase and Kenalog?
Protective gel/paste Makes it more comfortable for ulceration, erosions, sensitivity Kenalog is Orabase but with corticosteroid
34
3 Levels of corticosteroids used in treatment of OLP
Mild - Hydrocortisone 1% Moderate - Triamcinolone 0.02% Potent - Clobetasol 0.05%
35
What may potent corticosteroids be prescribed with?
Topical antifungals Ex. miconazole oral gel, nystatin, amphotericin * Due to risk of candida infection with prolonged corticosteroid use
36
What do specialists do to treat OLP
Systemic steroids (prednisone) Retinoids Laser treatment Topical calcineurin inhibitors PUVA (UV therapy)
37
If you take a histopathological biopsy and see dysplasia, is it still OLP?
No - becomes OPMD
38
Is there risk of LP for malignant transformation
Controversial * Risk probably \<1% * Single oral lichenoid lesions on tongue likely being dysplastic
39
What location of lichenoid lesions is likely actually be a dysplastic OLP
Single oral lichenoid lesions on tongue
40
When does OLP become clinically suspicious (could be PMD)
Atypical mucosal lesions Resistant to tx Heterogenous appearance (texture/color) Persistent erosions & ulceration
41
What is “patch testing” used for?
Used to differentiate between idiopathic OLP and oral lichenoid contact lesions
42
How does non-erosive, non-symptomatic LP get managed
Follow ups
43
How does erosive/symptomatic LP get managed (4)
Initially, focus on **eduation** and elimination of precipitating or provoking factors Make sure not dysplastic - **biopsy** **Topical steroids and antifungals** Follow up

DS4101 (43 decks)

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