LICHEN PLANUS

Question 1

CONCEPT

Answer 1

CHRONIC INFLAMMATORY MUCOCUTANEOUS DISEASE

Question 2

CAUSE

Answer 2

• UNKNOWN (CONSIDERED IMMUNOLOGICALLY-MEDIATED PROCESS - T-CALL MEDIATED)
• POSSIBLE INITIATORS MINORITY PATIENTS: DENTAL MATERIALS, STRESS, MEDICATION CAUSING LICHENOID MUCOSITIS

Question 3

TARGET

Answer 3

WOMEN (30-60 YEARS)

Question 4

CLINICALLY

Answer 4

• RETICULAR/EROSIVE (MOST COMMON ORALLY), PLAQUE, BULBS
• SKIN: PURPLE, PRURITIC, POLYGONAL PAPULES (AFFECTING FLEXOR SURFACES EXTREMITIES, GENITAL MUCOSA, NAILS)

Question 5

ORALLY CLINICALLY

Answer 5

• BUCCAL MUCOSA (MOST), TONGUE, GINGIVA, PALATE
• RETICULAR FORM: ASYMPTOMATIC BILATERAL WHITE PAPULES (CONNECT AND FORM NETWORK OF LINES - WICKHAM STRIES - PRODUCE ANNULAR OR LACY PATTERN) - NOT TREATMENT
• EROSIVE FORM: OPEN ORES, SYMPTOMATIC (BURNING, SENSITIVITY, GENERALIZED DISCOMFORT) - ERYTHEMATOUS, ATROPHIC AREAS WITH CENTRAL ULCERATION BORDERED BY THIN, WHITE RADIATING STRIAE - ONLY GINGIVA (DESQUAMATIVE GINGIVITIS)

Question 6

HISTOLOGICAL

Answer 6

• HYPERKERATOSIS (TICKENING OF THE GRANULAR CELL LAYER)
• DEVELOPMENT “SAW TOOTH” (APPEARANCE RETE PEGS)
• DEGENERATION BASAL LAYER OF CELLS “HYDROPIC DEGENERATION”
• BANDLIKE INFILTRATION OF INFLAMMATORY CELLS (PREDOMINANTLY T LYMPHOCYTES) IMMEDIATELY SUBJACENT TO THE EPITHELIUM
• CIVATTE BODIES (HYALINE BODIES): DEGENERATING KERATINOCYTES (SEEN IN THE EPITHELIUM/CONNECTIVE TISSUE INTERFACE)

Question 7

SIMILAR HISTOPATHOLOGIC PATTERN

Answer 7

• LICHENOID DRUG REACTION
• LICHENOID AMALGAM REACTION
• ORAL GRAFT-VERSUS-HOST DISEASE
• LUPUS ERYTHEMATOSUS
• CHRONIC ULCERATIVE STOMATITIS
• ORAL MUCOSAL CINNAMON REACTION

Question 8

TREATMENT

Answer 8

• RETICULAR: NOT TREATMENT (ASYMPTOMATIC)
• EROSIVE: TOPICAL CORTICOSTEROIDS (BETAMETHASONE, FLUOCINONIDE, CLOBETASOL GEL) - AN AUTOIMMUNE DISEASE

Question 9

DIAGNOSIS

Answer 9

• COINCIDENTAL OCCURRENCE OF LICHEN PLANUS AND ORAL CANCER: CLINICAL OVERDIAGNOSIS OF LICHEN PLANUS/MICROSCOPIC CONFUSION WITH LICHENOID FEATURES ASSOCIATED WITH DYSPLASIA HAVE CAUSED TO THE CONTROVERSY OVER MALIGNANT POTENTIAL TRANSFORMATION OF LICHEN PLANUS (RISK EXIST - SMALL LESS 1%)
• MOST DOCUMENTED CASES ARE RELATED TO THE EROSIVE OR THE PLAQUE FORM OF LICHEN PLANUS (WHY PATIENTS SHOULD BE OBSERVED PERIODICALLY EVERY 3, 6 MONTHS OR ANNUALLY - DEPENDS ON THE CLINICAL PRESENTATION)