Lichen Planus Flashcards

(42 cards)

1
Q

What is lichen planus?

A

A chronic disease, affecting 1% of the population.

Typically those aged 30-50

Can be idiopathic, drug related, or rarely related to systemic disease.

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2
Q

What types of lichen planus are there?

A

Reticular
Atrophic/erosive

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3
Q

How would you determine if a lichen planus was atrophic?

A

If there is an accompanied erythemous change (redness)

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4
Q

How would you determine if a lichen planus was erosive?

A

If there is yellowish fiberous covering over the base of the connective tissue, where there is very little epithelium left.

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5
Q

Histologically how would you identify lichen planus?

A

Chronic inflammatory cell infiltration

Saw tooth rete ridges

Basal cell damage

Partchy acanthosis

Parakeratosis

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6
Q

What is the mechanism by which the epithelium changes during a lichenoid reaction?

A
  • Lymphocyte activation
  • Overeaction to normal triggers
  • Can be triggered by hep C, herpes, amalgam, medicines.
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7
Q

Which drugs can trigger a lichenoid reaction?

A

ACE inhibitors
Beta-adrenergic blockers
Diuretics – Bendroflumethiazide, frusemide
NSAIDs
DMARDs
Gold

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8
Q

What can trigger lichenoid reactions?

A

Genetic factors
Physcial/emotional stress
Injury to skin
Localised skin disease
Systemic viral infection
Contact allergy (metals/amalgam)
Medications

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9
Q

What are the symptoms of lichen planus?

A

Often none
Thinning of epithelium may lead to sensitivty to hot/spicy food
Burning sensation in the mucosa

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10
Q

List two other conditions which gingival lichen planus may be confused with?

A

Gingival pemhigoid and plasma cell gingivitis.

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11
Q

Why might it be challenging to biopsy suspected gingival lesions?

A

Could damage junctional tissues attached to the bone/tooth. Risk loss of attachment for a biopsy that MAY be nothing.

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12
Q

How would you differentiate between plaque induced gingivitis and gingival lichen planus?

A

No clear band around the tooth
No enlarged tissue onto the tooth
Colour is consistant with that of tissue further down the tooth

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13
Q

What should be considered when taking a biopsy of the tongue?

A

Easy to take the sample but may be painful when healing.

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14
Q

What is the cause of lichen planus on the tongue?

A

Its usually idopathic, but lateral lesions may be caused by nearby amalgam.

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15
Q

Which metal in an amalgam filling is the cause of lichenoid reactions?

A

There has not been any one agent identified.

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16
Q

When should you consider removal of an amalgam to manage a lichenoid reaction?

A

If it is potentially malignant
If it symptomatic

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17
Q

What are the main management principles for lichen planus?

A

Removal of causative agent
Biopsy
Blood tests
Local topical agents
Topical steroids

18
Q

What topical steroids should be given in a primary care setting?

A

Beclomethasone MDI 0.5mg/puff, 2 puffs 2-3/day

Betamethasone rinse, 1mg/10ml, 2mins/twice daily

19
Q

When should topical steroids be prescribed for oral lesions?

A

If they are persisting beyond typical remedies.

If they are symptomatic.

20
Q

What treatments for lichen planus can be given in a hospital setting?

A

Higher stregnth steroids (clobetasol)

Topical tacrolimus
Hydroxychloroquine
Systemic immunomodulators

21
Q

What is graft versus host disease?

A

A disease where the host immune cells reject grafted tissue, resulting in systemic issues including possible lichenoid reactions.

22
Q

In lichen planus Skin cases what is the percentage you are also likely to have oral lesions?

23
Q

In Lichen Planus oral cases what is the percentage with skin lesions?

24
Q

What type of Lichen Planus is this?

25
What type of Lichen Planus is this?
Atrophic / erosive
26
What type of Lichen planus is this?
- Ulcerative
27
What are the Oral lichen planus sites?
- Buccal mucosa - Gingivae (Desquamative Gingivitis) - Tongue (lateral aspect, dorsum) - Lips - Palate
28
What is the most common oral site for Lichen planus?
- Anywhere on Buccal mucosa but more likely on - Anterior at commisure - Mid - Posterior around 3 rd molar tooth - An easy biopsy site
29
When found in Isolation what is Gingival Lichen planus also called?
- Desquamative gingivitis - Has very erythematous appearance
30
What is very important in settling gingival lichen planus?
- OHI - Esp interdental - Seems plaque driven in many pts
31
What lichen planus is this?
- Gingival lichen planus
32
When Lichen planus is found on the Dorsum of the tongue what is its trigger?
- Usually idiopathic - Loss of papillae and smooth tongue surface
33
When Lichen planus is found on the lateral aspect of tongue what is the trigger usually?
- Drug or amalgam trigger - Amalgam most likely if there is isolated lateral tongue lesion - Drug if multiple lesion
34
What is this an example of?
- Tongue lichen planus
35
What is this a type of ?
- Lip lichen planus
36
During a lichenoid reaction what occurs histologically?
- Chronic inflammatory cell infiltrate - Saw tooth rete ridges - Basal cell damage - Parakeratosis
37
Describe what is going on histologically in this picture
***
38
What other sites of the body can be affected by Lichen Planus?
- Skin - Scalp - Genital - Hair - Nails
39
Histologically what disease is this picture showing?
- Lichen planus - Clear T cell infiltrate into the basal membrane area of connective tissues - The dark purple lymphocytic band hugging the basement membrane is key diagnostic feature of LP
40
Describe this Lichenoid reaction
- Chronic inflmmatory cell infiltrate (T cell) -Saw tooth rete ridges - Basal cell damage - Patchy acanthosis of epithelial layer - Parakeratosis of superficial epithelium
41
Using what occurs histologically what info does this give us in regard to Lichen Planus as a disease?
- Shows lymphocyte activation which means the body is attempting to remove a perceived threat - Most likley the langerhans cells in epithelium are presenting an antigen which triggers an immune response (T lymphocytes) to remove chronic irritation - causing change in epithelium - Lichen Planus does not have singular cause
42
What are some other thoughts to cause of LP?
- Genetic predisposition - Physical and emotional stress - Injury to skin called koebnerisation