Muco- Disorders - Lichen Planus Flashcards

1
Q

What age range is typical for lichen planus?

A

30-50 years old

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2
Q

What are different clinical presentations of lichen planus?

A

BED PR

Reticular 
Plaque like 
Erosive 
Bullous 
Desquamative gingivitis
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3
Q

How does lichen planus present?

A

Symmetrical and bilateral

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4
Q

What is lichen planus?

A

Type IV hypersensitivity - cell mediated auto-immune condition

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5
Q

Risk with lichen planus?

A

1-3% risk of malignant change

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6
Q

Do see skin involvement in lichen planus?

A

Less 10% of those with oral lesions have skin lesions

50% of those with skin lesions have oral lesions

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7
Q

What skin lesions see in lichen planus?

A

Purple, itchy papules
Wickham’s striae on shins
See on flexor surface wrist/ shins

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8
Q

What are other mucosal sites lichen planus can affect?

A

Oseophageal
Genital
Anal

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9
Q

What is koebner phenomenon in lichen planus?

A

Pt develops vesicles along scratch lines

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10
Q

What histology do you see in lichen planus?

A

Blue cells close to epithelium = lymphocytes - indicate autoimmune condition

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11
Q

What is pathology of lichen planus?

A

Band like accumulation T lymphocytes
Cell mediated damage to basal cells
Disruption basmenet membrane

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12
Q

What happens if rate of damage exceeds rate of repair?

A

Epithelial thinning - erosive lesions/ ulcerations

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13
Q

What happens if rate of repair exceeds rate of damage?

A

Epithelial thickening and keratinisation

Reticular and plaque like lesions

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14
Q

What is lichenoid reaction?

A

Lesions that look like oral lichen planus but no antigenic cause

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15
Q

What pathology of lichenoid reaction?

A

Band like infiltrate and epithelial damage

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16
Q

Cause of lichenoid reactions

A

Graft vs host disease
Contact sensitivity
Reaction to systematic drugs
SLE

17
Q

When is graft vs host seen?

A

Usually in bone marrow transplant

18
Q

What is graft vs host disease?

A

As pt had bone marrow transplant T cells not own - regard keratinocytes as foreign

19
Q

What is most common material to have contact sensitivity reaction with?

A

Amalgam

20
Q

What to do if suspect lichenoid reaction due material?

A

Lesion will be closely associated w/ filling
Pt needs patch test
Removing/ replacing restoration will resolve lesion 3-6 months

21
Q

Difference between OLP and OLR?

A

OLP: symmetrical, bilateral, may have skin lesions

OLR: unilateral, asymmetrical, don’t involve skin, closely related amalgam/ drug

22
Q

Treatment of OLP?

A

Topical agent - difflam (benzydamine)
Topical corticosteroids - prednisolone
Topical immunosuppressants - retinoids
Systemic immunosuppressant - azathioprine

23
Q

Management OLR?

A

Remove or tx underlying cause

If lesion doesn’t regress - tx for OLP