Dermatology Al Azhar University Gaza

1. Papulosquamous diseases
BY
SHATHA ABDELMAWLA ALSULH

2. ORAL LICHEN
PLANUS

3. Etiology and Pathogensis:
 Etiology not known
 T-lymphocyte cytotoxicity directed against antigens expressed by the
basal cell layer
 multifactorial: stress
 association with HCV
 Epidemiology
 OLP: 0.5%–2.2%.

4. Clinical Findings:Oral lichen planus
 To establish a clinical diagnosis of OLP, reticular or papular textures
have to be present
 different clinical manifestations are related to the magnitude of the
subepithelial inflammation
 Symptomes:
 Reticular, popular, plaque like: feeling of roughness
 Bullous, erythematous, ulcerative: smarting sensation

5.  Reticular: fine white lines
or striae , lace like or
annular, bilaterally in the
buccal mucosa

6.  Papular: initial phase of the disease , small white dots
Papular oral lichen planus with dense cover of
papules. In the upper left corner, the lesion has started to
form a more reticular structure.

7. Plaque-like: homogeneous well-demarcated
white plaque in conjunction with striae,
DD: oral leukoplakias, > smokers,
overrepresented in OLP transforming into oral
SCC.

8. A plaque-like oral lichen planus with a plaque in
the anterior part. In the posterior part, the lesion
has features that are compatible with the
reticular form.
A squamous cell carcinoma developed in a
plaque-like oral lichen planus.

9.  Bullous: very
unusual , bullous
structures
surrounded by a
reticular network.

10. Bullous OLP: Single vesicle with surrounding reticular whitish streaks

11.  Erythematous:
homogeneous red area with
striae in the periphery. If
exclusively affecting
attached gingiva:
desuamative gingivitis that
need histopathology

12. Desquamative gingivitis secondary to lichen planus.

13.  Ulcerative:
most disabling,
ulcers
surrounded by
erythema and
peripheral
white striae

14. Extraoral LP:
 Cutaneous lesions :
 6 P’s: planer (flat topped), pruritic, polygonal, purple, polished (shiny) papules, predilection sites
 may form plaques
 intense scratching
 Koebner phenomenon
 extra-oral mucosal site involved:
 the genital mucosa: 20%, VVG syndrome with erythematous or ulcerative OLP
 Esophageal lichen :dysphagia
 Hair: cicatricial alopecia
 Nail:5–10%
 Longitudinal ridging, splitting and Onycholysis, anonychia,Pterygium

15. Lichen planus, violaceous, flat-topped papules with minimal scale.

16. Linear lesions due to Koebner phenomenon in lichen planus

17. Cicatricial alopecia caused by lichen planus.

18. Lichen planus, nail involvement with pterygium

19.  Diagnosis:
 clinical diagnosis: by Papules or reticular components
 A biopsy
 Differential diagnosis:
 Oral GVHD
 Discoid lupus erythematosus (DLE)
 oral leukoplakia
 erythema multiforme
 ulcerative gingivitis

20. Pathology:
 hyperparakeratosis
 focal hypergranulosis
 Irregular acanthosis & saw-
toothed appearance of the rete
ridges
 interface dermatitis
 hydropic degeneration
 bandlike lymphocytic infiltrate
 melanophages

23. Management:
 No preventive therapies
 reducing or eliminating symptoms.
 topical drugs :
 Steroids: clobetasol propionate, triamcinolone acetonide.
 calcineurin inhibitors (cyclosporine, tacrolimus and pimecrolimus)
 retinoids
 ultraviolet phototherapy
 systemic steroids for recalcitrant lesions
 OLP is considered to be a premalignant disorder : Albeit the risk is low, a minimum of annual monitoring
has been suggested in conjunction with routine dental examination by the general dental practitioner

24. Thank you