8/10/2019 12 Lichen Planus

http://slidepdf.com/reader/full/12-lichen-planus 1/7

1

Lichen Planusand Lichenoid Mucositis

 All pictures are intellectual property of the Division of Oral andMaxillofacial Pathology or its Faculty. Duplication or any

unauthorized use is prohibited.

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

8/10/2019 12 Lichen Planus

http://slidepdf.com/reader/full/12-lichen-planus 2/7

2

8/10/2019 12 Lichen Planus

http://slidepdf.com/reader/full/12-lichen-planus 3/7

3

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

8/10/2019 12 Lichen Planus

http://slidepdf.com/reader/full/12-lichen-planus 4/7

4

Treatment

• Topical corticosteroids

• Systemic corticosteroids

• Cytotoxic medications

Malignant Potential of Lichen Planus

• Lichenoid dysplasia

• Chronic cases of lichen planus

 – Erosive

 – Long-standing

 – <3.0%

8/10/2019 12 Lichen Planus

http://slidepdf.com/reader/full/12-lichen-planus 5/7

5

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

8/10/2019 12 Lichen Planus

http://slidepdf.com/reader/full/12-lichen-planus 6/7

6

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

8/10/2019 12 Lichen Planus

http://slidepdf.com/reader/full/12-lichen-planus 7/7

7

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