Lichen planus is a chronic inflammatory skin and mucous membrane disease characterized by violaceous papules that may form plaques. Oral lichen planus commonly presents as striae - sharply defined white lacy patterns - but can also be erosive, atrophic, or bullous. CD8 T cells trigger apoptosis of oral epithelial cells. Treatment aims to reduce symptoms, resolve lesions, and prevent oral squamous cell carcinoma through topical corticosteroids, systemic medications, surgery or laser, with complications including infection and malignant transformation requiring careful long-term follow-up.

2.  Presenter
 Dr. Nusrat Fahmida Trisha

3. Lichen Planus is
 common chronic inflammatory disease
of skin and mucous membrane
 presence of cutaneous violaceous
papules that may coalesce to form
plaques

4. Types of Oral
Lichen Planus

5. Striae
Most common
Sharply defined
snowy white, lacy,
starry or annular
patterns
Not palpable or
firmer than the
surrounding mucosa

6. Erosive
shallow irregular area of epithelial destruction
 very persistent and may be covered by smooth,
slightly raised yellowish layer of fibrin
margins may be slightly depressed due to fibrosis
and gradual healing at the periphery
striae may radiate from the margins of these
erosions

7. Atrophic
 red areas of mucosal thinning
 often combined with striae

8. Plaques
 occasionally seen in early stages
particularly on the dorsum of the
tongue

9. Bullous form
 Raised fluid filled lesions
 Short lived on gingiva
resulting in an ulceration

10. Ulcerative form
 fibrin coated
ulcers
 surrounded by
an erythematous
zone frequently
displaying white
striae

11. Pathogenesis
of Oral
Lichen Planus

12. CD8 T cell trigger the apoptosis of oral epethelium cell
These cells become cytotoxic for basal keratinocytes
Liquefaction degeneration of basal keratinocytes

13. Contributing Factor
of
Oral Lichen Planus

14.  Immune system has a primary role in the
development of this disease
Predisposing factor
Genetic background
Dental material
Drugs
Infectious agent
Habits
 Trauma
 Diabetes and hypertension
 Stress
 Miscellaneous associations

15. Diagnosis
Clinical features
Investigation
Treatment

16. CLINICAL FEATURES:
 Patients usually over 40 years ,Children are rarely
affected
 Females account for at least 65% of patients
 Untreated disease can persist for 10 or more
years
 Common sites are:
 Buccal mucosae
 Dorsum of tongue
 Gingivae (infrequently)
 Lip(mucosal side
 Posterior buccal mucosa ( most common site )

17. Lesions usually bilateral and often
symmetrical Cutaneous lesions only
occasionally associated
 Striae alone may be asymptomatic, but
atrophic lesions are sore and erosions cause
more severe symptoms
Eating becomes difficult

18. Gingival
lichen planus
CLINICAL FEATURES
Lesions are usually
atrophic, so gingivae
appear shiny, inflamed
and smooth
Only limited segments
of the gingivae may be
affected.

19. Soreness caused by atrophic
lesions makes tooth brushing
difficult
Plaque accumulation and
associated inflammatory changes
appear to aggravate lichen planus

20. Investigation
Incisional biopsy
ANA test
Immunofluorescent studies- Fluorecent dyes like
FITC Immunoglobulin assay
PAS staining

21. Histological features
 Hyperkeratosis or parakeratosis
Saw-tooth profile of the rete ridges
Saw-tooth rete ridges

22. Liquefaction degeneration
of the basal cell layer
Compact, band-like
lymphoplasmacytic
(predominantly T-cell)
infiltrate cells hugging the
epithelio-mesenchymal
junction
 CD8 lymphocytes
predominate in relation to
the epithelium
Basal cell degeneraton
Infiltration of lymphocytes

23. Treatment

24. No treatment for oral lichen planus is
curative
Goal:
• Reduce painful symptoms
• Resolution of oral mucosal lesion
• Reduce risk of Oral SCC
• Improve oral hygiene
• Eliminate exacerbating factor
• Diet
• Reduce stress

25. • Medication:
o Topical corticosteroid
o Systemic corticosteroid
o cyclosporin
o Griseofulvin
o Retinoids
o Prophylactic use of 0.12%
Chlorhexidine mouthwash
• Surgery
• laser
• photochemotheraphy

26. Complication
1.OLP and its treatment may predispose
people to oral candida albicans super
infection.
2. Malignant Transformation: Reported
transformation rates vary from 0.5 to 2%
over a period of 5 years. -Erosive and
atrophic forms commonly undergo
transformation.
3. Oral SCC in patients with OLP is a
controversial issue.

27. Case presentation

28. Particulars of patient
•Name- Mrs. Salina
•Age-45 y
•Sex -female
•Reg no-3492/130
•Address-Mirpur 10, Dhaka
Chief complaint
•Burning sensation in the mouth for 6 months
H/o present illness
• According to the statement of the patient she was
reasonably well 6 months back. Then she developed
burning sensation in the mouth for last 6 months while
consuming spicy food and bilateral pigmentation on the
inner part of cheek. She is diabetic. Now she admitted to
DDCH for better management.

29. Intraoral examination
On intraoral examination, a greyish brown patch with white
striae were observed in the posterior buccal mucosa
extending into retromolar fossa. Lesions are non tender on
palpation. No other mucosa or skin surface showed lesional
change
Diagnosis
Oral lichen planus
Treatment
• Scaling
• Oral hygiene maintain
• Trialon ointment
• Mouthwash

31. Oral lichen planus is a complex and poorly
understood clinical condition which can not be
cured. A definitive diagnosis and careful,
conscientious follow-up are imperative..Symptoms
and complications are common and challenging
but may be managed with a variety of therapies
including orally administered and systemic
medications as well as lifestyle alterations and
reduction of precipitating factors.
Conclusion

32. REFERENCE
CAWSON’S ESSENTIALS OF
ORAL PATHOLOGY AND ORAL MEDICINE
By R.A. Cawson and E.W. Odell