Lichen Planus Flashcards
Diagnose
Reticular lichen planus
Lacy white lines across mucosa
Diagnose
Ulcerative lichen planus
How can lichen planus present on other areas of the body
Striae on the nail
Raised patches on wrists and sometimes with wickham striae
Symptoms of lichen planus?
Often none
Often related to thinning of epithelium
- sensitive to hot / spicy
- burning sensation in mucosa
Common sites for lichen planus?
Buccal mucosa (most common)
Gingiva (desquamative gingivitis)
Tongue
Lips
Palate
What presentations may gingival lichen planus show?
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
Why may tongue lichen planus present?
Dorsum lichen planus usually idiopathic
Lateral border may have a drug or amalgam trigger
- amalgam most likely if isolated
What meds commonly induce lichen planus?
ACE inhibitors
Beta blockers
Diuretics
NSAIDS
DMARDS (disease modifying anti rheumatic drugs)
- sulphasalazine
Characteristics of lichenoid drug reactions
More often widespread
Often bilateral
Often poorly responding to standard steroid treatment
What considerations need to be made with regards to managing drug induced lichenoid reactions?
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!
What considerations when managing amalgam lichen planus?
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
How manage lichen planus
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
What can be done to manage mild intermittent lichen planus?
Topical OTC
- chlorhexadine
- benzdamine
Avoid SLS containing toothpaste
- sensodyne pronamel
How treat persisting symptomatic lesions?
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
When must lupus be considered?
How is it different
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.
What is the histology of oral lichen planus
Parakeratosis
Patchy acanthosis
Civatte bodies - dead keratinocytes
Saw tooth rete ridges
Thick band of T cell lymphocytes hugging basement membrane
