Lichen Planus

Question 1

What different clinical presentations of lichen planus are there?

Answer 1

Reticular
Atrophic/erosive
–where atrophic extends to the point of having no epithelium at all, that is ulcerative or erosive
Ulcerative

Question 2

What is lichen planus?

Answer 2

Lichen planus is a mucocutaneous disorder which affects the oral mucosa and/or skin.
Characterised by the presence of white patches which principally affect the buccal mucosa, lips, tongue and attached gingivae in a bilateral and symmetrical pattern

Question 3

What is gingival lichen planus?

Answer 3

Can be found in isolation
Can be very patchy

Question 4

Why is biopsying gingival lichen planus difficult?

Answer 4

Risk of damaging the attachment area of the gingiva/tooth
Adherent attached mucosa damaged lifting from the bone
Take care deciding to biopsy gingival lesions
Should only be done where there is a good clear margin of gingiva between tooth and lesion

Question 5

What is tongue lichen planus?

Answer 5

Dorsum is usually idiopathic
-loss of papillae and smooth tongue surface
Lateral aspect may have drug/amalgam trigger
-amalgam most likely if there is an isolated lateral tongue lesion
-look at tongue position at rest to see if there is amalgam contact
Early biopsy site but painful when healing

Question 6

Where should you biopsy for lichen planus?

Answer 6

Lichen planus is not a precisely defined clinical entity and if biopsy material is to be obtained a sample should be taken from a ‘typical area’ of mucosa and not from areas of erosion.

Question 7

What indicates if it is a lichenoid reaction rather than lichen planus?

Answer 7

Asymmetry of the lesion and involvement of the palate indicates a lichenoid reaction