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Lichen planus
Lichen planus
Lichen planus
Lichen planus
Lichen planus
Lichen planus
Lichen planus
Lichen planus
Lichen planus
Lichen planus
Lichen planus
Lichen planus
Lichen planus
Lichen planus
Lichen planus
Lichen planus
Lichen planus
Lichen planus
Lichen planus
Lichen planus
Lichen planus
Lichen planus
Lichen planus
Lichen planus
Lichen planus
Lichen planus
Lichen planus
Lichen planus
Lichen planus
Lichen planus
Lichen planus
Lichen planus
Lichen planus
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Lichen planus

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  • 1. ORAL LICHEN PLANUS Dr shabeel pn ROYAL DENTAL COLLEGE
  • 2.  
  • 3. Oral Lichen Planus
    • Common mucocutaneous disease with varying clinical presentation
    • Wilson 1869
    • Lichen Ruber planus
    • Premalignant condition
    • Involvement of oral mucosa is frequent along with or preceded by lesions on skin and genital mucous membrane
  • 4. Definition
    • OLP is a rather common chronic mucocutaneous disease which probably arises due to abnormal immunological reaction and the disease have some tendency to undergo malignant transformation
  • 5. Lichenoid reactions
    • Exhibits clinical and histological similarity
    • Distinguished from OLP on the basis of
    • 1. association with administration of drug, contact with a metal, use of food flavors or systemic diseases
    • 2. Resolution when the cause is eliminated or when disease is treated
  • 6. Epidemiology
    • Very common- 1% of population
    • In Indians 1.5%(average)
    • 3.7% mixed oral habits
    • 0.3% non users of tobacco
    • Risk more among who smoke and chew tobacco
    • cutaneous lesion alone 35%
    • mucosal lesion alone 25%
    • both together 40%
  • 7. Etiology
    • Specific etiology is unknown
    • Psychological stress
    • No evident genetic bias or no uniform etiologic factors
    • Abnormal recognition and expression of basal keratinocytes of epithelium as foreign antigens by langerhans cells
  • 8. Pathogenesis
    • CD8 + T cells trigger the apoptosis of oral epithelial cells
    • They recognize an antigen which is similar to an antigen associated with major histocompatability complex class 1 on keratinocytes
    • They release cytokinins that attract additional lymphocytes which accumulate in sub basilar connective tissue
    • Liquefaction degeneration of basal keratinocytes
  • 9. Clinical Features
    • Age- middle aged or elderly people
    • mean age of onset- 5 th decade of life
    • rarely in young adults and children
    • More in females ( 1.4:1 )
    • Site- both skin lesions and mucosal lesions are present
    • Grinspan’s syndrome –OLP, DM & HP
  • 10. Skin Lesions
    • Purple, pruritic and polygonal papules
    • May be discreet or gradually coalesce into plaques each covered by fine glistering scale
    • Bilaterally symmetrical
    • Increase in size if subjected to any irritation
    • Usually self limiting unlike the oral lesions lasting only one year or less
    • Initially red > purple or violaceous hue > a dirty brownish color
    • Periods of regression and recurrence
    • “ Koebner’s phenomenon”- skin lesions extend along the areas of injury or irritation
    • Most often on wrist, forearms, knees, thighs and trunk
    • Face remains uninvolved
  • 11.  
  • 12. Mucosal Lesions
    • Normally asymptomatic
    • Bilaterally symmetrical
    • Sometimes simultaneously have OSF, leukoplakia,etc.
    • Clinical types
    • 1.reticular
    • 2.atrophic
    • 3.erosive
    • 4.bullous
    • 5. other types
  • 13. Reticular type
    • Most common and most readily recognized form
    • Slightly elevated fine whitish lines (Wickham’s striae) in lace like or annular pattern
    • Lines are wavy and parallel
    • A tiny elevated dot like structure at the point of intersection of lines
    • Commonly on buccal mucosa and buccal vestibule
    • Sometimes on tongue, gingiva, lips and floor of the mouth
  • 14.  
  • 15.  
  • 16. Atrophic type
    • Keratotic changes combined with mucosal erythema
    • smooth, poorly defined erythematus areas with or without peripheral striae
    • Usually associated with desquamative gingivitis
    • Pain and burning sensation
  • 17. Erosive type
    • Pseudo membrane covered ulcerations with keratosis and erythema
    • Severe form with extensive degeneration and separation of epithelium from connective tissue
    • Faint white zone resembling radiating striae seen at the junction with normal epithelium
    • Pain, burning sensation, bleeding, desquamative gingivitis
    • Commonly on buccal mucosa and vestibule
    • More dysplasia and malignant transformation
  • 18.  
  • 19. Bullous type
    • Vesciculobullous presentation combined with reticular or erosive pattern
    • Rare form characterized by large vesicles or bullae (4mm to 2cm)
    • Lesions usually develop within an erythematus base, rupture immediately leaving painful ulcers
    • Usually have peripheral radiating striae and seen on posterior part of buccal mucosa
  • 20.  
  • 21. Other types
    • Plaque type : flattened white areas
    • -dorsal surface of tongue
    • -often resemble leukoplakia
    • Hypertrophic type : well circumscribed, elevated white lesion resembling leukoplakia
    • -biopsy needed for diagnosis
    • Pigmented type : rarely erosive type can be associated with diffused
    • -usually on buccal mucosa and vestibule
    • -reticulated white patches with or without a red erosive component flanked brown macular foci
  • 22.  
  • 23.  
  • 24. Histopathology
    • Hyper orthokeratinisation or hyper parakeratinisation
    • Thickening of granular layer
    • Acanthosis of spinous layer
    • Intercellular oedema in spinous layer
    • “ Saw-tooth” rete pegs
    • Liquefaction necrosis of basal layer- Max Joseph spaces
    • Civatte ( hyaline or cytoid) bodies
    • Juxta epithelial band of inflammatory cells
  • 25.  
  • 26.  
  • 27. Immunofluorescent Studies
    • Band of fibrinogen in the basement membrane zone
    • Multiple IgM staining cytoid bodies in dermal papilla or peribasalar area
    • Highly suggestive of lichen planus if present in clusters
  • 28. Differential Diagnosis
    • Lichenoid reactions
    • Leukoplakia
    • Candidiasis
    • Pemphigus
    • Cicatricial pemphigoid
    • Erythema multiforme
    • Syphilis
    • Recurrent aphthae
    • Lupus erythematosus
    • Squamous cell carcinoma
  • 29. Malignant transformation
    • Controversy
    • Increased risk of oral squamous cell carcinoma
    • Frequency of transformation is low, between 0.3% and 3%
    • Erosive and atrophic forms commonly undergo transformation
  • 30.  
  • 31. Treatment
    • No cure
    • Management of symptoms
    • Principal aims: resolution of painful symptoms, resolution of mucosal lesions, reduction of risk of cancer & maintenance of good oral hygiene
    • Corticosteroids: both systemic & topical
    • Topical:
    • 0.05% fluocinonide ( Lidex)
    • 0.05% clobetasol ( Temovate)
    • as pastes or gels
    • Candida overgrowth
  • 32. References
    • Burket’s Oral Medicine – 10 th Edition
    • Shafer’s Oral Pathology – 5 th Edition
    • Essentials of Oral Pathology
    • www.emedicine.com
    • www.medscape.com
  • 33. THANK YOU CREATIVE SUPPORT BY PATRICK GEORGE

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