12 lichen planus

8/10/2019 12 Lichen Planus

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Lichen Planusand Lichenoid Mucositis

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What is Lichen Planus

• Common, dermatologic disease• Often affects oral mucosa

• Flat lesions like lichens

• Immunologic disorder

• Lichenoid mucositis

• Association with hepatitis C

• Stress induced?

Clinical Features• Prevalence: 0.1%-2.0%

• Middle-aged adults

• Women

• Skin: Purple pruritic papules at the flexor

surfaces, Wickham’s striations

• Oral mucosa

– Reticular

– Erosive

Oral Lesions

• Reticular – Usually no symptoms

– Posterior buccal mucosa bilaterally

– Interlacing white lines (Wickham’s striae)

– Wax and wane

• Erosive – Symptomatic

– Atrophic erythematous areas

– Periphery: fine radiating striations

– Gingiva: desquamative gingivitis

– Bullous lichen planus



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Diagnosis

• Clinical features

– Reticular

– Erosive

• Incisional biopsy

– Parakeratosis, orthokeratosis, hyperkeratosis

– Thickness of spinous layer varies, “saw-tooth”

– Hydropic degeneration of basal cell layer

– Degenerative epithelial cells (Civatte bodies)

– No significant dysplasia



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Treatment

• Topical corticosteroids

• Systemic corticosteroids

• Cytotoxic medications

Malignant Potential of Lichen Planus

• Lichenoid dysplasia

• Chronic cases of lichen planus

– Erosive

– Long-standing

– <3.0%



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Desquamative Gingivitis

• Erosive lichen planus

• Cicatricial pemphigoid

• Pemphigus vulgaris

• Bullous pemphigoid

• Linear IgA disease

• Epidermolysis bullosa acquisita

• Systemic lupus erythematosus

• Chronic ulcerative stomatitis

• Paraneoplastic pemphigus

• Hormone mediated desquamative gingivitis

• Abnormal response to plaque



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Desquamative Gingivitis

• A clinical descriptive term• Most cases are pemphigoid or lichen planus

• Chronic ulcerative stomatitis: unresponsiveto steroids

• >40 years of age; females

• Gradual onset

• Facial gingiva

• Tx: Excellent DH; doxycycline monohydrate,topical corticosteroids, dapsone orsulfapyridine

Lichenoid Reaction to Dental

Materials

• Lichenoid gingivitis: after periodontal

curettage and polishing; placement of crowns

• Lichenoid reaction to amalgam

– Reaction to mercury or mercury compound (!?)

– Galvanic currents (not proven)

– Lesions directly in contact with the restoration

– Tx: Remove restoration and replacement with

composite, gold crown or PFM

Lichenoid Reaction to Medications

• Box 9.3; Page:348

• Work with the physician

• Immunofluorescence: Indirect method; IgG

reaction featuring “string of pearls” pattern;

basal cell cytoplasmic antibody.

Contact Stomatitis from

Artificial Cinnamon

• Gingiva: Plasma cell gingivitis

• Exfoliative cheilitis and perioral dermatitis

• Gum and candy: buccal mucosa and

lateral tongue

• Lesions look like frosting, or lupus

erythematosus-like, frictional

hyperkeratosis-like, hairy leukoplakia-like,

lichenoid



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Contact Stomatitis from

Artificial Cinnamon

• Histology

– Can be diagnostic (depends on who reads it)

– Similarities with lupus

Graft vs. Host Disease

• Recipients of allogeneic BMT

• HLA-matched donor

• Leukemia, aplastic anemia, metastatic disease

• Implanted cells attack tissues of the host

• Acute and chronic GVHD

• Mild rush to diffuse necrolysis

• Oral lesions: Sometimes only finding, lichenoid

12 lichen planus

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