Lichen Planus Flashcards
What is lichen planus
an immune reaction to an unknown antigen stimulus in the epithelium
cell mediated immune reaction with early t4 cell presence and late T8 cell presence
What does lichen planus look like
a white lacey patch across normal mucosa or erythematous change
Types of hypersenstivity
Type 1 - anaphylactic , allergy (immediate type)
Type 2 - antibody mdiated type (cytotoxic - antigen on own cells antibody reaction)
Type 3 - immune complex type
Type 4 - Tcell mediated type - delayed, immediated by T lymphocytes
Causes of lichen planus
medicines
contact allergy
amalgam resotrations
genetic predisposition
injury to skin - isomorphic response
physical and emtional stress
drugs - ACE, beta blockers, diruetics, NSAIDS
Systemic viral infection
Different forms of lichen planus
PPBREAD
Plaque
Papular
Bullous
Reticular
Erosive/Ulcerative
Atrophic
Desquamative Gingivitis
Reticular lichen planus commonly found
buccal mucosa
Can lichen planus cause malginancy
Yes review after 1 year
What type of hypersenstivity reaction is lichen planus?
Type IV - T cell mediated type
Management of lichen planus
Remove known cause - meds, restorations
Improve Oh - CHX mw, bezadamine mw
Avoid SLS toothpaste
Symptomatic - topical steroids, - beclomethasone, bethamethsone
Analgesic - difflam
Hospital setting - hydroxychloquine or systemic immodulators
Biopsy when is it done?
No symptoms, non smoker, reticular type = no biopsy
Pain and smoker = biopsy
Smoker, regardless of type = biopsy
Is there a basal cell layer present in lichen planus?
No
What do the cells look like when apoptosis occurs?
Cells surrounded by a halo
Hisotlogy of lichen planus
- Keratinasation
- Lymphocytes/marophages
- Hyperplsia/atrophy
- apoptosis
- Basal cell liquiefaction leading to colloid cells
- Blue band of chronic inflammatory cells
- Saw tooth rete rdiges (not always)
Perivascular infiltrate
the mononuclear inflammatory cells infiltrate around the venules indicate this this is a delayed type of hypernsenstivity reaction
What does epitheliotropism indicate in the epithelial layer
lymphocytes are present
