Oral Lichen Planus (OLP) Flashcards
Lichen planus (LP):
Definition:
Lichen planus (LP) is a chronic, inflammatory, mucocutaneous, immune-mediated condition with variable clinical presentations
Lichen planus (LP):
LP may involve the:
- Skin
- oral cavity
- hair follicles (lichen planopilaris, resulting in scarring alopecia)
- nails
- esophagus, and, more seldom,
- the eyes, urinary tract, nasal mucosa, and larynx
It usually presents with recurrences and periods of clinical exacerbations and remissions; however, it may be a transient disorder
Lichen planus (LP):
Pathogenesis:
- Much is still not known about the etiopathogenesis of OLP
- OLP is characterized by a chronic T-cell inflammatory infiltrate with basal cell degeneration including vacuolar degeneration, hyperkeratosis or parakeratosis, and saw- tooth rete ridges
Lichen planus (LP):
The most commonly involved oral sites are the:
- buccal mucosa
- lateral surfaces of the tongue
- gingivae
Lichen planus (LP):
Six clinical patterns of OLP are described:
- reticular
- plaque-like
- atrophic
- erosive/ulcerative
- papular
- bullous
Lichen planus (LP):
Reticular lesions:
- The reticular lesions, the most recognized form of OLP, encompass white lesions, which appear as a network of connecting and overlapping lines referred to as Wickham striae, papules, or plaques
- Although some patients may display an impressive array of diffuse and wide- spread reticulated lesions, they rarely complain of symptoms and often are unaware of their presence
Lichen planus (LP):
Erosive form of OLP:
- The erosive form of OLP may present with erythema caused by inflammation or epithelial thinning, or both, and ulceration/pseudomembrane formation with periphery of the lesion surrounded by reticular keratotic striae
- If the erosive subtype of OLP only affects the gingival tissue, the descriptive clinical term desquamative gingivitis is used
- OLP is confined to the gingiva in about 10% of patients
- Erosive lesions resembling those observed in other vesiculobullous diseases including pemphigoid, pem- phigus, linear IgA disease, and foreign body gingivitis can also produce desquamative gingivitis not easily identified as OLP unless there are coexistent reticular lesions on the gingiva or elsewhere in the oral cavity
Lichen planus (LP):
Histo- pathological criteria:
- WHO histopathologic criteria
- Presence of well-defined band-like zone of cellular
- infiltration that is confined to the superficial part of the connective tissue, consisting mainly of lymphocytes
- Signs of “liquefaction degeneration” in the basal cell layer
- Degenerating keratinocytes may be seen in the area of the epithelium and connective tissue interface and have been termed colloid, cytoid, hyaline, or Civatte bodies
- Absence of epithelial dysplasia
- When the histopathological features are less obvious, the term “histopathologically compatible with” should be used
Lichen planus (LP):
Vacuolar degeneration:
- Vacuolar degeneration (also called liquefaction degeneration) is the intracellular vacuole formation in injured basal keratinocytes and separation of the plasma cell membrane from the underlying basement membrane
- Vacuolar degeneration is seen in lichenoid reactions like cutaneous lupus erythematosus, dermatomyositis, drug reaction
- If the injury is severe, the cell undergoes apoptosis and becomes a Civatte body (colloid body)
Lichen planus (LP):
Modified WHO diagnostic criteria of OLP and OLL (van der Meij and van der Waal 2003):
Clinical criteria:
- Presence of bilateral, more or less symmetrical lesions
- Presence of a lacelike network of slightly raised gray- white lines (reticular pattern)
- Erosive, atrophic, bullous, and plaque-like lesions are only accepted as a subtype in the presence of reticular lesions elsewhere in the oral mucosa
- In all other lesions that resemble OLP but not complete with the aforementioned criteria, the term “clinically compatible with” should be used
Lichen planus (LP):
Modified WHO diagnostic criteria of OLP and OLL (van der Meij and van der Waal 2003):
Histo- pathological criteria:
- Presence of well-defined band-like zone of cellular infiltration that is confined to the superficial part of the connective tissue, consisting mainly of lymphocytes
- Signs of “liquefaction degeneration” in the basal cell layer
- Absence of epithelial dysplasia
- When the histopathological features are less obvious, the term “histopathologically compatible with” should be used
Lichen planus (LP):
Modified WHO diagnostic criteria of OLP and OLL (van der Meij and van der Waal 2003):
Final diagnosis of OLP or OLL:
To achieve a final diagnosis, clinical as well as histopathological criteria should be included
OLP: a diagnosis of OLP requires fulfillment of both clinical and histopathological criteria
OLL: the term OLL will be used under the following conditions
- Clinically typical of OLP but histopathologically only “compatible with” OLP
- Histopathologically typical of OLP but clinically only “compatible with” OLP
- Clinically “compatible with” OLP and histopathologically “compatible with” OLP
Lichen planus (LP):
Describe the lesion Diagnosis?
DD Management
- Presents in a bilateral, symmetrical pattern with the buccal mucosa (bilaterally) being the most typical site of involvement
- Other common sites of involvement include the tongue gingival labial mucosa, and vermilion of the lower lip
- Patients with isolated lip lesions and tongue lesions have been described although many patients who present with isolated lesions eventually develop more widespread disease
- Lesions of OLP affecting the palate, floor of the mouth, and upper lip are not common
Lichen planus (LP):
Differential Diagnosis:
- Oral lichenoid lesions
- oral lichenoid drug reaction
- oral lichenoid contact hypersensitivity reaction chronic graft-versus-host disease
- chronic ulcerative stomatitis
- lupus erythematosus
- The plaque-like OLP occurs more frequently is difficult to distinguish it from oral leukoplaki
- The gingival lesions caused by mucous membrane pemphigoid or pemphigus vulgaris may appear as “desquamative gingivitis”
Lichen planus (LP):
Treatment:
The most currently accepted and reliable therapeutic modality is the use of topical steroids with consideration to be given for use of systemic steroids in cases of severe widespread disease and/or refractory cases
