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Prof Thomson > Week 7- Oral Lichen Planus > Flashcards

Week 7- Oral Lichen Planus Flashcards

1
Q

What are examples of oral lichenoid reactions?

A
  • Oral lichen planus
  • Oral lichen planus associated with underlying disease
  • Lichenoid contact reactions
  • Drug-induced lichenoid reactions
  • Graft vs host
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2
Q

What is characteristic of oral lichenoid reactions and lupous erythematous?

A

Acquired lesions that can’t be scraped off and have a specific pattern

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3
Q

What is lichen planus?

A

Chronic inflammatory disease affecting skin and mucous membrane. Oral lesions may present alone or with concomitant skin lesions.

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4
Q

Describe prevalence of OLP

A
  • 4th decade of life
  • Affects women more frequently
  • Affects 1-2% of population
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5
Q

How can lichen planus present clinically?

A
  • Reticular
  • Papular
  • Plaque-like
  • Erosive
  • Atrophic
  • Bullous
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6
Q

What are the common sites of oral lichen planus?

A
  • Buccal mucosa
  • Tongue
  • Gingiva
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7
Q

Describe skin lesions from lichen planus

A
  • Violaceous flat-topped papules on ankles, wrist and genitalia
  • Facial skin is spared
  • Nail deformities
  • Alopecia
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8
Q

What are lichen planus lip lesions often confused with?

A

Actinic cheilitis

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9
Q

What is desquamative gingivitis and its clinical presentation?

A

Erythema extends beyond the marginal gingiva, involving the full width of the gingiva and sometimes the alveolar mucosa

  • Erythematous gingiva
  • Desquamation and erosion of gingival epithelium
  • Blister formation
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10
Q

What conditions is desquamative gingivitis common in?

A
  • Lichen planus
  • Pemphigoid
  • Pemphigus
  • Dermatitis herpetiformis
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11
Q

What is the pathogenesis of Lichen Planus?

A

T-cell mediated autoimmune disease in which the auto-cytotoxic CD8 + T cells trigger apoptosis of the basal cells of the oral epithelium.

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12
Q

What virus may be considered an etiological factor in OLP?

A

Hep C virus

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13
Q

What is the difference between CD4 and CD8 T cells?

A
  • CD4 T cells are the helper T cells, which assist other blood cells to produce an immune response,
  • CD8 T cells are the cytotoxic T cells that induce cell death either by lysis or apoptosis
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14
Q

What are essential features for LP histopathology?

A
  • ‘Liquefaction degeneration’ in basal cell layer
  • Well-defined band of T cells in superficial connective tissue
  • Absence of dysplasia
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15
Q

What are non essential features of LP?

A
  • ‘Saw tooth’ rete ridge configuration
  • Parakeratosis
  • Civatte bodies
  • Separation of epithelium from lamina propria due to basal cell destruction
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16
Q

What are civattte bodies?

A

Remnant of necrotic basal cells

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17
Q

What is the pathognomonic clinical appearance of LP?

A

Interlacing white reticular striae on bilateral posterior buccal mucosa

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18
Q

What are DD for LP?

A
  • Frictional keratosis
  • Oral lichenoid reaction
  • Oral leukoplakia
  • Lupus erythematosus
  • Pemphigus
  • Mucous membrane pemphigoid
  • Erythematous candidiasis
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19
Q

What should you do to confirm diagnosis of LP?

A

Biopsy for histopathological confirmation

20
Q

How are lichenoid drug reactions diagnosed?

A
  • Unilateral and accompanied by hx of new drug intake
  • Most reliable diagnostic aid is to observe rx resolving on drug withdrawal and returning when patient re-challenged
21
Q

What drugs are associated with lichenoid drug reactions?

A
  • Anti-hypertensives
  • Anti-diabetic
  • Anti-thyroid
  • Anti-malarials
  • NSAIDs
22
Q

What are dental restorative material induced lichenoid reactions usually caused by & where do they appear?

A

Usually caused by amalgam and are confined to areas of oral mucosa in close proximity

23
Q

What does biopsy reveal about dental restorative material induced lichenoid reaction?

A

Diffuse lymphocytic infiltrate rather than subepithelial band

24
Q

What are characteristics of lupus erythematosis?

A
  • Resemble LP but are less symmetrically distributed
  • Keratotic striae of LE are more delicate and show characteristic radiation from central focus
25
Q

What does biopsy reveal for lupus erythematosus?

A

Perivascular infiltrate

26
Q

How can vesiculo-bullous disorders be differentiated from erosive or atrophic OLP?

A
  • Both pemphigus and pemphigoid are solitary erythematous lesions with no white striae.
  • Peeling of epithelium from CT junction on slight lateral pressure in non-affected areas differentiates from OLP
  • Biopsy reveals intra-epithelial or subepithelial splitting
27
Q

What form of LP is erythema multiforme similar to and how is it differentiated?

A
  • Resembles bullous OLP
  • Acute and involves labial mucosa
28
Q

How can LP be managed initally?

A
  • Pt education (chronic disorder, no curative tx, symptomatic relief)
  • Active pt monitoring
  • Supportive measures (eliminate precipitating factors, minimise trauma to oral mucosa)
  • Supplemental measures (dilute CHX)
  • Topical treatments
29
Q

What are topical treatments for OLP?

A
  • Dilute CHX
  • Kenalog (corticosteroid) in Orabase (protective paste)
30
Q

What are the therapeutic aims of lichen planus management?

A
  • Minimise immune-mediated inflammatory response
  • Avoid opportunistic infections
  • Simple
  • Empirical
31
Q

What can you do if pt doesn’t respond to supportive measures to manage OLP?

A

Consider referral to OMFS

32
Q

What are corticosteroids often paired with when treating OLP? Why?

A

Topical antifungal agents (miconazole nystatin amphotericin). Long term steroid use can lead to candida

33
Q

What are special care measures for OLP?

A
  • Systemic steroids
  • Retinoids
  • Topical calcineurin inhibitors
  • PUVA
  • Laser tx
34
Q

What lichenoid lesions have higher chance of malignant transformation?

A

Single oral lichenoid lesion on tongue

35
Q

If dysplasia is present, can it be considered OLP?

A

No, it is an OPMD.

36
Q

What lesions are clinically suspicious?

A
  • Atypical
  • Heterogenous appearance (texture and colour)
  • Tx resistance
  • Persistent erosions and ulceration
37
Q

What can be used to differentiate between idiopathic OLP and oral lichenoid contact lesions?

A

Patch testing

38
Q

Does asymptomatic OLP need to be treated?

A

No

39
Q

What is this?

A

Oral lichenoid reaction to amalgam?

40
Q

What are the characteristic features of this?

A

Lichen planus skin lesion

  • Whickham’s Striae: slender white lines​
  • Koebner Phenomenon: raised white lesion at sites of trauma
41
Q

What are the following presentations of LOP (L-R)?

A

Papular

Reticular

Erosive-ulcerative

42
Q

What is this?

A

Erosive/ulcerative lichen planus

43
Q

What is this presentation of lichen planus?

A

Bullous

44
Q

What is this?

A

Desquamative gingivitis (associated with LP)

45
Q

What is this histopathological sample indicating and what is the arrow pointing to?

A

Lichen planus. Arrow is pointing to civatte body

46
Q

What is this?

A

Erythroleukoplakia

47
Q

What is the management algorithm for lichen planus?

A

Prof Thomson (6 decks)

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