OLP and lichenoid tissue reactions Flashcards
(38 cards)
1
Q
what is lichen planus
A
a common chronic immune mediated mucocutaneous disease
2
Q
where can it commonly affect
A
- mucosa
-skin
-ano-genital mucosa
more rare
- pharynx
-conjunctiva
3
Q
difference between OLP and OLL
A
- clinically look identical
- similar histopathological features
- OLP - no specific identifiable etiological factor
OLL- identifiable aetiological factor or manifestation of systemic disease
4
Q
OLR ??
A
reaction - caused by drug or material
5
Q
clinical problems associated with OLP and OLL
A
- very common
- often painful
- no cure
- can be a manifestation of systemic disease
- it has a 1% risk of malignant transformation over 10 years
6
Q
epidemiology of OLP/OLL
A
- commonly presents between the ages of 30-65
- slight female predilection
- no racial predilection
7
Q
genetics role in OLP/OLL
A
- association with HLA - which codes for how our immune system works
an association with genes encoded at Chromosome 6 (where MHC is encoded) and lichen planus
8
Q
factors which increase OLP/OLL risk
A
- immune system - CD8 and 4
- genetic - HLA type
environment - trauma, stress, medication, restorative materials
9
Q
immunopathogenesis of OLP
A
- dependent on adaptive immune responce
- CD8+ T cell mediated destruction of basal keratinocytes
- these cells activated in lymph node by antigen-presenting cells expressing MHC I
- they recognise an antigen presented on MHC I on basal keratinocytes
- upon recognition of antigen release of granzyme and perforin to disrupt the cell membrane leading to cell death
also release of TNF- alpha - influnce CD4+ T cells
10
Q
risk factors for OLP/OLL
A
- stress
- genetics
- medications
- dental materials
- viral infection
- chronic trauma
- lupus - can present as a lichenoid lesion
- graft versus host disease
- diabetes
- hypertension
- autoimmune diseases
- nutritional deficiency - can exacerbate symptoms
- sodium lauryl sulphate - foaming agent in toothpaste
11
Q
what things in social history increase malignancy risk
A
- smoking
- alcohol
-betel - low socioeconomic status
12
Q
clinical features of OLP/OLL
A
white patch
- red patch - desquamative gingivitis
- erosion/ulcer
13
Q
what are the types of OLP
A
14
Q
what is reticular OLP
A
- reticular - net like pattern
-lacy appearance - asymptomatic
-spontaneously resolve
15
Q
what is atrophic OLP
A
- red mucosa
- thinning of mucous membrane
- desquamative gingivitis
16
Q
what is papular OLP
A
- multiple white papules
uncommon
17
Q
what is erosive OLP
A
- erosions - similar appearance to an ulcer but resemble partial loss of epithelium
- if there is an ulcer in OLP/OLL it is still termed erosive
- symptomatic
- risk of malignant chance
- keep close eye
-irregular pattern
18
Q
what is plaque like OLP
A
- thickened white plaque
- similar to white patches
19
Q
what is bullous OLP
A
- uncommon
- superficial mucoceles
20
Q
where is common in mouth for OLP/OLL
A
- bilateral/symmetrical
- buccal mucosa and tongue most common
- if OLTR - then might be near etiological factor
- if on palate and floor - consider lupus
21
Q
differences in clinical features of OLP and OLTR
A
22
Q
what to say to patient if diagnosed with OLP/OLL
A
- describe what it is
-non curable
-immune mediated - caused by - genetics, environment
- common
-range of TX - risk of malignant change
23
Q
management of OLP and OLL
A
- clinical photos
- OHI and PMPR If desquamative
-change amalgam restorations - SLS free toothpaste
- refer
-symptomatic relief
24
Q
when would you refer OLP/OLL
A
- symptomatic
- unilateral/non-symmetrical distribution
- any non-reticular lichen planus
- unclear diagnosis
- the patient has other risk factors for malignant change
- you think a biopsy is indicated
- on side of tongue lesion - always refer - high malignant potential
25
what is symptomatic relief for OLP/OLL
-benxydamine 0.15% MV or spray
- betamethasone MW 500mcg
if 1 highly localised lesion then beclomatasone 50 mcg inhaler
- hydrocortisone oromucosal tablet - 2.5mg
26
what is management of OLP/OLL in secondary care
- same as primary
- exclude systemic disease
- if symptomatic or erosive - FBC, haematinics , oral rinse to exclude final infection
27
risks of biopsy
- pain
-bleeding
- swelling
- infection
-altered sensation
28
benefits of biopsy
- confirms diagnosis
- may identify dysplasia
- can exclude vesicuobullous
29
what are types of biopsy
- Incisional biopsy for H & e staining
- If wishing to exclude blistering disease also undertake incisional biopsy for Direct Immunofluorescence
- An incisional punch or free-hand ellipse is generally appropriate
30
what as histological features of OLP/OLL
- death of basal keratinocytes/liquefaction
- colloid bodies (sometimes called civatte bodies)
- band like lymphocytic infiltrate - almost exclusively T cells
- higher CD8+ T cell frequency
- acanthosis
- hyperparakeratosisi or hyperorthokeratosis
- saw tooth rete pegs
- epithelial atrophy or erosion
- ?features of dysplasia
31
management of OLP and OLL
- remove amalgam
- possible stop medication
- topical steroid
- potent topical steroid
-systemic steroids
-topical cacineurin inhibitors
-hydroxychloroquine
-azathioprine
-mycophenolate mofetil
32
what are names of some medications used for OLP and OLL
-topical steroids
-prednisolone (systemic steroid)
- potent topical steroids (cobetasol of flucocinolone)
- topical calcineurin inhibitors (tacrolimus)
- hydoxychloroquine
- azathioprine (DMARD)
33
what is considered in high risk groups of patients with OLP/OLL
hep C
34
if recent stem cell transplant what should be considered
GVHD
35
if palatal distribution of OLP and systemic features like joint pain and rash what should be considered
lupus
36
what blood tests can be done for lupus
- anti-nuclear antibodies
- biopsy
- anti-smith
- anti-dsDNA
- complement
- immunoglobulins and protein electrophoresis
37
what are white areas over skin lesions termed in LP
wickhams striae
38
risks of cancer in OLP/OLL
- increase in symptom severity
- new lesions
- new onset ulcers
- exophytic lesions
- erythema
- dysphagia
- lymphadenopathy
- erosive
-tongue lesions
