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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
Q

How to differentiate OLP from lichenoid drug reaction

A

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
Q

What drugs can cause lichenoid drug reactions

A

“Anti-things”

  1. Anti-hypertensives
  2. Anti-inflammatory (NSAID)
  3. Anti-diabetic
  4. Anti-thyroid
  5. Anti-malarials
27
Q

How to differentiate OLP from vesiculo-bullous disorders (pemphigus, pemphigoid)

A

Pemphigus and pemphigoid are solitary erythematous lesions

no white striae

28
Q

How to differentiate lupus erythematosis from OLP

A

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
Q

Management of OLP

A

Patient education

Active patient monitoring

Supportive measures (elimination of provoking factors, minimize trauma to mucosa)

Supplemental measures (CHX - diluted)

30
Q

What does the pt need to be educated about regarding their OLP

A
  • It’s a chronic disorder - long term
  • No treatment availble
  • May require symptomatic relief
31
Q

Therapeutic aims of LP management (4)

A

Minimize the immune-mediated inflammatory response

Avoid opportunistic infections

Keep it simple

Empirical (based on observation)

32
Q

Topical “treatments” of OLP (3)

A

CHX - diluted

Orabase

Kenalog

33
Q

What is Orabase and Kenalog?

A

Protective gel/paste

Makes it more comfortable for ulceration, erosions, sensitivity

Kenalog is Orabase but with corticosteroid

34
Q

3 Levels of corticosteroids used in treatment of OLP

A

Mild - Hydrocortisone 1%

Moderate - Triamcinolone 0.02%

Potent - Clobetasol 0.05%

35
Q

What may potent corticosteroids be prescribed with?

A

Topical antifungals

Ex. miconazole oral gel, nystatin, amphotericin

  • Due to risk of candida infection with prolonged corticosteroid use
36
Q

What do specialists do to treat OLP

A

Systemic steroids (prednisone)

Retinoids

Laser treatment

Topical calcineurin inhibitors

PUVA (UV therapy)

37
Q

If you take a histopathological biopsy and see dysplasia, is it still OLP?

A

No - becomes OPMD

38
Q

Is there risk of LP for malignant transformation

A

Controversial

  • Risk probably <1%
  • Single oral lichenoid lesions on tongue likely being dysplastic
39
Q

What location of lichenoid lesions is likely actually be a dysplastic OLP

A

Single oral lichenoid lesions on tongue

40
Q

When does OLP become clinically suspicious (could be PMD)

A

Atypical mucosal lesions

Resistant to tx

Heterogenous appearance (texture/color)

Persistent erosions & ulceration

41
Q

What is “patch testing” used for?

A

Used to differentiate between idiopathic OLP and oral lichenoid contact lesions

42
Q

How does non-erosive, non-symptomatic LP get managed

A

Follow ups

43
Q

How does erosive/symptomatic LP get managed (4)

A

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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