oral lichen planus

lichenlichen lichen

introduction

“Oral lichen planus is a chronic immunologic inflammatory mucocutaneous disorder commonly found in oral cavity, where it appears as white, reticular, plaque or erosive lesions.”

Erasmus Wilson, 1869

٭ Symptomatic oral lichen planus is painful and complete healing is rare

epidem

epidemiology

٭ Prevalence - 1.27 %٭ More frequent in women٭ Age: 30 - 60 yrs٭ Malignant potential is less than

1%

clinica

clinical appearance

Presents with various manifestation such as٭ Reticular٭ Papular٭ Plaque٭ Atrophic٭ Ulcerative٭ Bullous

٭ Most common

٭ Usually asymptomatic

٭ Appears as a network of overlapping white striae

٭ Commonly seen bilaterally in buccal mucosa, tongue, gingiva, mucobuccal fold or multiple sites

clinical appearancereticular papular plaque atrophic ulcerative bullous

٭ Usually present in the initial phase of the disease٭ Clinically characterized by small white dots٭ Most occasion which intermingle with reticular

form

clinical appearancereticular papular plaque atrophic ulcerative bullous

٭ Seen as a homogenous well demarcated white plaque

٭ Most common in smokers

٭ On cessation of smoking plaque may disappear and convert to reticular type

٭ Resemble homogenous oral leukoplakia

٭ Simultaneous presence of reticular or papular structures in case of plaque like oral lichen planus

clinical appearancereticular papular plaque atrophic ulcerative bullous

٭ Characterized by homogenous red area

٭ Commonly associated with desquamative gingivitis

٭ Requires a histopathologic examination in order to arrive a diagnosis

clinical appearancereticular papular plaque atrophic ulcerative bullous

٭ Most disabling of lichen planus

٭ Clinically – fibrin coated ulcers surrounded by an erythematous zone frequently displaying radiating white striae

٭ Sub epithelial inflammation - most prominent at center of the lesion

٭ Smarting sensation in conjunction with food intake

clinical appearancereticular papular plaque atrophic ulcerative bullous

clinical appearancereticular papular plaque atrophic ulcerative bullous

٭ Small bullae or vesicles that rupture easily, leaving painful, ulcerated surface

Current data suggest that OLP is a T- cell mediated autoimmune disease in which auto- cytotoxic CD8 T-cells trigger apoptosis of oral epithelial cells

To date, a specific antigen responsible for the develop of OLP remains un-identified

etiopathogenesis

The rest of the epithelium appears to react with thickening of spinous layer (acanthosis) and granular cell layer (parakeratosis or orthokeratosis)

The rete ridges adopt a ‘saw tooth configuration’

etiopathogenesis

diagnosisOral manifestation of OLP maybe sufficient to make a correct diagnosis

However, oral biopsy with histopathological evaluation is recommended to confirm the clinical diagnosis, and to exclude the dysplasia and malignancy

(Scully, 2008)

medicines given

٭ Steroids Betamethasone Clobetasol Dexamethasone Triamcinolone

٭ Calcineurin inhibitors Tacrolimus Cyclosporin Pimecrolimus

٭ Retinoids

٭ Photo chemotherapy

٭ Newer traditional medicine – Aloe Vera

treatm

Various treatment regimens have been attempted to improve the lesions and

reduce the associated pain, but a cure for OLP has not yet been accomplished

because of its recalcitrant nature.

?

treatment protocolasymptomatic

follow up – 3 month

symptomatic

follow up

response response

antifungal therapy no response no response

no response

positive

check for candidiasis

biopsy

no response

?

• improve oral hygiene

• avoid precipitating factors (drugs, foods, chemicals)

• reassurance

topical steroidstriamcinolone acetonide

betamethasone

tacrolimus

candida positive

follow up

systemic steroids

refere

thank you