Lichenoid Reactions

Question 1

What medications can produce a lichenoid reaction?

Answer 1

ACE inhibitors (ramipril) , beta-adrenergic blockers (atenolol), diuretics (frusemide), NSAIDs (ibuprofen), DMARDs (methotrexate)

Question 2

What can cause lichenoid reactions?

Answer 2

Most are idiopathic- no known cause
Some are related to medication
Some are related to amalgam restorations
Where the cause is known the oral lesion is often described as a lichenoid reaction to (it is diagnosed and managed as LP but usually the known cause is removed)

Question 3

How do you manage an amalgam related lesion?

Answer 3

If asymptomatic then do nothing
Replacing the restoration will increase tooth damage
No routine need to replace other amalgam restorations

Question 4

How do you manage lichen planus?

Answer 4

Remove any cause (medicines, dental restorations)
Biopsy (unless a good reason not to)
Blood tests
–haematinics
–FBC

Question 5

How would you treat mild intermittent lesions?

Answer 5

Topical OTC remedies
–chlorhexidine m/w
–benzdamine m/w
Avoid SLS containing toothpaste

Question 6

How would you treat persisting symptomatic lesions in a primary care setting?

Answer 6

Topical steroids
–Beclomethasone MDI 0.5mg/puff 2 puffs 2-3 times daily
–Betamethasone rinse - 1mg in 10ml for 2 minutes twice a day

Question 7

How would you treat persisting symptomatic lesions in a hospital setting?

Answer 7

Higher strength topical steroids- puffer or rinse
Clobetasol cream - mixed with orobase
Cream can be applied in a veneer for gingival lesions
Topical tacrolimus- ointment or mouthwash
Hydroxychloroquine (works on both cutaneous and oral lichen planus)
Systemic immunomodulators
–Azathioprine, mycophenolate

Question 8

What can palatal lesions indicate?

Answer 8

Could indicate lupus
Lupus erythematosus can look similar to lichen planus

Question 9

When is graft vs host disease common?

Answer 9

Common after a stem cell transplant/BMT