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BDS 4: Oral Medicine > Lichen Planus and Lichenoid Reactions > Flashcards

Lichen Planus and Lichenoid Reactions Flashcards

1
Q

How can LP affect the nails?

A

Can cause longitudinal grooving and pitting (normally reversible)
Or lose the nail entirely

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2
Q

Which of the 7 LP variants is a lichenoid reaction most likely to present as?

A

Likely to be erosive form

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3
Q

What variant of oral LP is this?

A

Erosive (ulcerative)

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4
Q

Which ethnicities are more affected by oral LP?

A

Europeans and Indians

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5
Q

What variant of oral LP is this?

A

Erythematous (atrophic)

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6
Q

What ages are most commonly affected by oral LP?

A

40-80

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7
Q

What is the malignancy chance of Oral LP?

A

Variable transformation rate ~ 0.5-2%

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8
Q

What is oral lichen planus?

A

A chronic inflammatory condition that affects mucous membranes inside your mouth

This condition is pre-malignant

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9
Q

What is the best diagnostic tool for drug induced lichenoid reaction?

A

Removal of the drug

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10
Q

If a patient has skin LP what is the likelihood they have oral LP?
And Vice versa?

A

70 - 77% of skin LP patients have oral lesions
10 - 30 % of oral LP patients have skin lesions

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11
Q

How do you manage a lichenoid reaction?

A

Careful drug history needs to be taken and time relationship with appearance of lesions established
May consider patch testing if local causes
Resolution of the lesions should occur on withdrawal of drug

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12
Q

What type of drugs can induce a lichenoid reaction?

What other specific drugs outside those categories can induce a lichenoid reaction?

A
  • Beta-blockers (E.g. Propranolol, Atenolol)
  • ACE Inhibitors (E.g. Captopril & Enalapril)
  • Diuretics (E.g. Furosemide, Indapamine, Mannitol)
  • NSAIDs (E.g. Aspirin & Ibuprofen)
  • Anti-malarial
  • Oral Hypoglycaemics

Specific drugs
- Penicillamine (Rheumatoid Arthritis treatment)
- Allopurinol (Gout treatment)
- Gold Salts (Rheumatoid Arthritis treatment)
- Methyldopa (Hypertension treatment)

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13
Q

Where are extra-oral LP lesions of the skin commonly found?

A

Symmetrical distribution, usually on flexor surfaces of wrists/shins or sites of trauma

Koebner phenomenon

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14
Q

What systemic corticosteroids can be used to treat oral LP?

A

Prednisolone
Deflazacort

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15
Q

What Topical Calcineurin Inhibitors can be used to treat oral LP?

A

Ciclosporin
Tacrolimus
Pimecrolimus

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16
Q

What histopatholgical features would you expect to see with LP?

A
  1. Subepithelial band of inflammatory cells
  2. Basal cell liquefaction (Destruction of basement membrane)
  3. Hyperkeratosis

Pic 1 = 1 / Pic 2 = 2

17
Q

What is Koebner phenomenon?

A

Where LP lesions often in increased friction or trauma area

18
Q

How do you treat asymptomatic oral LP?

A
  • Reassure patient & review
  • Pt should be informed of malignant risk & encouraged to attend regularly
  • Pt should be made aware lesions may develop outside of the mouth
  • Advised to maintain good OH and Smoking/drinking cessation

NO CURE Just aim to reduce pain & inflammation and prevent complications

19
Q

What are the differences in duration for oral and skin presentations of LP?

A

Oral - range 4 - 25 years, mean 7 years
Skin - 18 months on average

20
Q

What dental materials can induce a lichenoid reaction?

A
  • Metallic restorative materials (E.g. Gold/Amalgam/Nickel)
  • Resins (Bis-GMA)
21
Q

Describe how skin LP lesions look

A

Red papules that turn purple, flat and polygonal in shape
Surface network of fine white striations (Wickham’s striae)

22
Q

What is the difference between a lichenoid reaction and LP?

A

A lichenoid reaction is similar in clinical presentation & histology to LP but has a more defined aetiology:
* Drug-induced or Dental material related

23
Q

What variant of oral LP is this?

A

Papular

24
Q

Which gender is more affected by oral LP?

A

60% Females

25
Q

What topical corticosteroids can be used to treat oral LP? (3)

A

Hydrocortisone
Betamethasone
Benzydamine (difflam)

26
Q

What are the 7 morphological variants of Oral LP lesions?

A

Erythematous (Atrophic)
Erosive (Ulcerative)
Plaque-like
Reticular
Bullous
Circinate
Papular

27
Q

What is the first line therapy for LP?

A

Topical corticosteroids

28
Q

What sites in the mouth have a higher presentation of oral LP?

A

Lesions often in increased friction or trauma area (Koebner phenomenon)

29
Q

What variant of oral LP is this?

A

Plaque-like

30
Q

How do you treat symptomatic oral LP?

A
  • Eliminate provoking factors of mechanical trauma
  • Reduce chemical irritation (spicy/acidic food & SLS-free toothpaste in desquamative gingivitis)
  • Good OH & CHX mouthwash & smoking/drinking cessation

NO CURE Just aim to reduce pain & inflammation and prevent complications

31
Q

Are Oral LP lesions commonly unilateral or bilateral?

A

Lesions are commonly bilateral (mirrored)

32
Q

The aetiology of Lichen Planus is unknown, what are some proposed theories?

A

Maybe Autoimmune (cytotoxic T cells)
OR
Related to stress, spicy foods, diabetes or liver disease

33
Q

How can LP affect the hair?

A

Can cause permanent scarring leading to alopecia

34
Q

What variant of oral LP is this?

A

Reticular

35
Q

What variant of oral LP is this?

A

Circinate

36
Q

Where are extra-oral LP lesions of the skin commonly found?

A

Symmetrical distribution, usually on flexor surfaces of wrists/shins or sites of trauma

Koebner phenomenon

37
Q

What is a very important piece of information you have to tell a patient with LP?

A

Patients should be informed of the risk of malignant transformation

BDS 4: Oral Medicine (15 decks)

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