13 - Managing lichen planus Flashcards
1
Q
When the cause of the lichen planus is know, what is the lesion referred to as?
A
Lichenoid reaction to …
2
Q
What are common medications that cause lichen planus?
A
- ACE inhibitors
- beta-adrenergic blockers
- diuretics (frusemide)
- NSAIDs
- DMARDs
- phenothiazines
3
Q
What DMARDs cause lichen planus?
A
- peniciilamine
- gold
- sulpasalazine
4
Q
Describe how a lichenoid drug reaction presents.
A
- widespread
- bilateral and mirrored
- poorly responsive to steroid treatment
5
Q
How do you manage a lichenoid drug reaction?
A
- weigh up benefit of drug vs stopping and the discomfort of the lichen planus
- is there an alternative drug option (discuss with GP)
6
Q
How do you manage a lichenoid amalgam reaction?
A
- if asymptomatic, monitor
- if symptomatic, consider changing amalgam (composite, GI, crown)
7
Q
What is the management of idiopathic lichen planus?
A
- remove any possible causes
- biopsy
- blood tests (haematinics, FBC, autoantibody screen if lupus suspected)
- topical OTC remedies
- avoid SLS toothpaste
8
Q
What are examples of OTC remedies for lichen planus?
A
- chlorhexidine mouthwash
- benzdamine mouthwash
9
Q
What are examples of SLS free toothpastes?
A
- sensodyne pronamel
- kingfisher
- oronurse
10
Q
What is the management of persisting symptomatic lichen planus lesions?
A
- in primary care, topical steroids (as ulceration)
- in secondary care, higher strength topical steroids, topical tacrolimus, hydroxychloroquine, systemic immunomodulators
11
Q
What topical steroids are available in primary care?
A
- beclomethasone MDI
- betamethasone mouthwash
12
Q
What systemic immunomodulators are used to treat lichen planus?
A
- azathioprine
- mycophenolate
13
Q
What can present similarly to lichen planus?
A
- GVHD (graft virus host disease, lymphocytic disease)
- lupus (changes are found deeper in tissue on histological slides)
