Lichen Planus Flashcards

1
Q

Diagnose

A

Reticular lichen planus

Lacy white lines across mucosa

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2
Q

Diagnose

A

Ulcerative lichen planus

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3
Q

How can lichen planus present on other areas of the body

A

Striae on the nail

Raised patches on wrists and sometimes with wickham striae

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4
Q

Symptoms of lichen planus?

A

Often none

Often related to thinning of epithelium
- sensitive to hot / spicy
- burning sensation in mucosa

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5
Q

Common sites for lichen planus?

A

Buccal mucosa (most common)

Gingiva (desquamative gingivitis)

Tongue

Lips

Palate

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6
Q

What presentations may gingival lichen planus show?

A

Can be found in isolation

Can give very erythematous appearance to gingivae

Can be very patchy or reticular

Erythematous all the way to sulcus vs localised to margin in gingivitis

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7
Q

Why may tongue lichen planus present?

A

Dorsum lichen planus usually idiopathic

Lateral border may have a drug or amalgam trigger
- amalgam most likely if isolated

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8
Q

What meds commonly induce lichen planus?

A

ACE inhibitors

Beta blockers

Diuretics

NSAIDS

DMARDS (disease modifying anti rheumatic drugs)
- sulphasalazine

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9
Q

Characteristics of lichenoid drug reactions

A

More often widespread

Often bilateral

Often poorly responding to standard steroid treatment

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10
Q

What considerations need to be made with regards to managing drug induced lichenoid reactions?

A

Risk / benefit
- of stopping drug tx
- and of lichenoid reaction

Mild lichen symptoms - unlikely to stop drug

Significant symptoms - can stop drug where max topical or systemic treatment needed to control lichen symptoms

Speak with patients GP!

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11
Q

What considerations when managing amalgam lichen planus?

A

Often from older amalgams so could be the corrosive products

Consider changing restoration however may not always be the most ideal situation

Potentially malignant so leaving it is not always sensible even if asymptomatic

Avoid amalgam removal during pregnancy

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12
Q

How manage lichen planus

A

Remove Cause
- medicines - ace inhibitors or beta blockers etc
- dental restorations - management of amalgam

Biopsy
- unless good reason not to e.g. gingival location

Blood tests
- haematinics
- FBC
- autoantibody screen if lupus is suspected

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13
Q

What can be done to manage mild intermittent lichen planus?

A

Topical OTC
- chlorhexadine
- benzdamine

Avoid SLS containing toothpaste
- sensodyne pronamel

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14
Q

How treat persisting symptomatic lesions?

A

Topical steroids - as for oral ulcers

Beclomethasone MDI 0.5mg / puff - 2 puffs - 2-3 times daily

Hospital setting - higher strength topical steroids
- clobetasol ‘skin’ steroid cream

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15
Q

When must lupus be considered?

How is it different

A

Any palatal reaction that looks like lichen planus
‘Butterfly’ rash on front of face

It is a chronic inflammatory condition where there is immune complex deposition into tissues round the body. These produce an immune response.

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16
Q

What is GVHD

A

Graft vs host disease

Looks like lichen planus however very common after stem cell transplant / BMT

17
Q

What is the pathogenesis of oral lichen planus thought to be?

What other causes may there be?

A

T cell immune response - type 4 hypersensitivity reaction
- Langerhans cells present an antigen leading to lymphocytic infiltration
- activation of CD8 T-cells phagocytose epithelial cells at basal cell layer

Physical and emotional stress

Trauma

Genetic predisposition - FH

Localised disease - HZV

Systemic viral infection - Hep C

Contact allergy - amalgam

Drugs - ace inhibitors, gold, beta blockers

18
Q

What is the histology of oral lichen planus

A

Parakeratosis

Patchy acanthosis

Civatte bodies - dead keratinocytes

Saw tooth rete ridges

Thick band of T cell lymphocytes hugging basement membrane

19
Q

Estimated prevalence of OLP?

In who more common?

A

0.5-2%

Slight female predisposition

Age of onset between 30-60 years

20
Q

Different management methods if OLP/OLL is symptomatic or asymptomatic?

A

Asymptomatic
- reassure
- monitor
- OHI
- avoid risk factors
- identify cause if OLL
- consider referral if high risk site
- topical corticosteroids

Symptomatic
- referral
- topical corticosteroids