Oral Lichen Planus

1. ORAL LICHEN
PLANUS
Clinical presentation
Drugs that can cause oral lichenoid
reaction
Management
Presented by: Dr Nurul Nuha Mohamad Shofi

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DEFINITION
EPIDEMIOLOGY
ETIOLOGY
CLINICAL APPEARANCES
OUTLINE
ORAL LICHEN PLANUS

3. 5
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MANAGEMENT
TREATMENT
EDUCATION OF OLP
CASE REPORT

4. DEFINITION Oral lichen planus
Common chronic inflammatory mucocutaneous
disorder that typically affects the oral mucosa &
additionally in some cases; the skin
The British Society for Oral Medicine (Guidelines for the Management of Oral Lichen Planus In Secondary Care) - October 2010

5. EPIDEMIOLOGY
More frequent in women
2:1
Age 30-60 years
Malignant potential
<1% Most prevalent
intraoral location
Buccal mucosa
92%

6. Nobody knows the
exact causes of
lichen planus
Autoimmune disease
ETIOLOGY

7. CLINICAL
PRESENTATION

8. Reticular Papular Atrophy Erosive
Bullous
Plaque
White lesion Red lesion Ulcerated lesion
Commonly found
on the cheeks
(bilaterally)
Lacy web-
like, white threads
that are slightly
raised
Asymptomatic
?
?
CLINICAL APPEARANCES OLP

9. Reticular Papular Atrophy Erosive
Bullous
Plaque
White lesion Red lesion Ulcerated lesion
Typically arise on
the buccal
mucosa & dorsum
of tongue,
although may also
present on other
mucosal surfaces
Small white raised
areas approximately
1-2mm in diameter
May represent an
early manifestation
of the condition
CLINICAL APPEARANCES OLP
?
?

10. Reticular Papular Atrophy Erosive
Bullous
Plaque
White lesion Red lesion Ulcerated lesion
Clinically
resembles
leukoplakia
Can range from
smooth, flat areas
to irregular,
elevated areas
Commonly found
on the dorsum of
the tongue and
on the buccal
mucosa
CLINICAL APPEARANCES OLP
?
?

11. Reticular Papular Atrophy Erosive
Bullous
Plaque
White lesion Red lesion Ulcerated lesion
Differential Dx: Leukoplakia
White patches or plaque which cannot be
characterized clinically or pathologically
as any other disease (WHO)
OLP (plaque)
Irregular, elevated areas
CLINICAL APPEARANCES OLP

12. Reticular Papular Atrophy Erosive
Bullous
Plaque
White lesion Red lesion Ulcerated lesion
Mix of erythematous
& ulcerated areas
surrounded by finely
radiating keratotic
striae
Significant discomfort
CLINICAL APPEARANCES OLP
?

13. Reticular Papular Atrophy Erosive
Bullous
Plaque
White lesion Red lesion Ulcerated lesion
CLINICAL APPEARANCES OLP

14. Reticular Papular Atrophy Erosive
Bullous
Plaque
White lesion Red lesion Ulcerated lesion
Intraoral bullae are
present on the buccal
mucosa and the lateral
borders of the tongue
CLINICAL APPEARANCES OLP
?
The bullae rupture soon
after they appear à
classic appearance of
ulcerative/erosive OLP

15. Reticular Papular Atrophy Erosive
Bullous
Plaque
White lesion Red lesion Ulcerated lesion
Gums are involved, described
as Desquamative Gingivitis
*Nikolsky sign à skin finding
top layers of the skin slip away from
the lower layers when slightly rubbed
(result of minor trauma)
May exhibit positive Nikolsky’s sign
25%
CLINICAL APPEARANCES OLP
?

16. Reticular Papular Atrophy Erosive
Bullous
Plaque
White lesion Red lesion Ulcerated lesion
CLINICAL APPEARANCES OLP

17. ORAL LICHENOID REACTION
ORAL LICHENOID LESIONS
ORAL LICHENOID MUCOSITIS
DRUG-INDUCED ORAL LICHENOID REACTION
A variant of oral lichen planus (OLP)
Although the precise aetiology of OLP is
unknown, the OLR/OLL are disease conditions
with definite identifiable aetiology

21. Diabetes
Mellitus
OLP Erosive
Hypertension
GRINSPAN’S SYNDROME
DRUG INDUCED DISORDER
GRINSPAN’S SYNDROME

23. q Record site, preferably photographically
q Consider site, histology, age and health of the patient, in conjunction w/ aetiologically factors
à before deciding on long-term observation or active intervention (take proper history)
q Completely stop pt from smoking (advise to adopt healthy lifestyle)
q Observation may consist clinical examination w/ repeated biopsy if change is seen
q Rx options
q Follow up at 3-monthly intervals
MANAGEMENT OF ORAL LICHEN PLANUS

24. HOW CAN ORAL LICHEN PLANUS BE TREATED?
TO DATE, THERE IS NO CURE FOR OLP

25. Anti-inflammatory or anaesthetic mouthwashes
Topical corticosteroids in the form of creams,
sprays or ointments for oral use
01
02
Systemic corticosteroids or other immunosuppresants
(for more severe cases)
03
Maintenance of optimum oral hygiene!
Especially for OLP that involves the gums
• Poor oral hygiene can worsen the condition
04

26. HOW TO EDUCATE
PATIENT WITH
ORAL LICHEN
PLANUS?

27. The chronicity of OLP and the expected periods of
exacerbation and quiescence
Aim of tx à specifically the elimination of mucosal
erythema, ulceration, pain and sensitivity
The possibility that several tx may need to be tried
The possibility of reducing the risk of oral cancer

28. CASE REPORT

30. CASE REPORT: HISTORY TAKING
§ C/C: Burning sensation of his right & left buccal
mucosa since 1 year.
§ HOPI: Aggravated on eating spicy food.
§ SH: A smoker for the past 30 years.
§ MH: Hypertensive and under medication.
63yo/♂/race unknown

31. CASE REPORT: INTRAORAL EXAMINATION
§ A white lesion with fine lacy radiating lines
measuring 2 cm × 3 cm
§ Similar greyish white areas were also observed in
the left retromolar pad region.
§ A reddish white lesion w/ fine lacy radiating
lines as well as in the retromolar pad region
extending up to the upper buccal vestibule.
§ The lesion was tender on palpation.
§ However, there were no areas of shallow ulceration.
§ Both sides the lesions were non-scrapable.
§ Rest of the mucosa had a blackish pigmentation.
§ He had no history of skin lesions.
RIGHT
BUCCAL
MUCOSA
LEFT
BUCCAL
MUCOSA
Reddish white lesion with keratotic striae
White lesion with keratotic striae
candidiasis

32. CASE REPORT: DX, MX & TX PLANNING
§ Based on the history and classic features of the lesion, the case was diagnosed as
§ Patient was advised to undergo all required dental treatments such as oral
prophylaxis and restorations.
§ He was prescribed with 0.1% triamcinolone acetonide for topical application.
§ The patient was reviewed after 3 weeks, and there was improvement in symptoms
and the lesions subsided.
§ Hence, biopsy was not performed in this case as there was a good response to
treatment.
Reticular Papular Atrophy Erosive
Bullous
Plaque Atrophy
ATROPHIC ORAL LICHEN PLANUS

33. Protocol/Algorithm For
Treatment
Of
Oral Lichen Planus

34. • Zain RB, Ikeda N, Reichart P, Axell T. 2002.Clinical Criteria for Diagnosis of Oral Mucosal Lesions: An Aid for Dental and Medical
Practitioners in the Asia-Pacific Region. Faculty of Dentistry, University of Malaya. Kuala Lumpur
• Scully, C. (2008). Oral and maxillofacial medicine- The basis of diagnosis and treatment. (2nd ed.) Elsevier.
• Eisen D, Carrozzo M, Bagan Sebastian JV, Thongprasom K: Number V Oral lichen planus: Clinical features and management. Oral
Dis 2005; 11:338-349.
• van der Meij EH, Schepman KP, van der Waal I: The possible premalignant character of oral lichen planus and oral lichenoid lesions: A
prospective study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003; 96:164-171.
• Bornstein MM, Kalas L, Lemp S, et al: Oral lichen planus and malignant transformation: A retrospective follow-up study of clinical and
histopathologic data. Quintessence Int 2006; 37:261-271.
• Roosaar A, Yin L, Sandborgh-Englund G, et al: On the natural course of oral lichen lesions in a Swedish population-based sample. Oral
Pathol Med 2006; 35:257-261.
• Al-Hashimi I, Schifter M, Lochart PB, et al: Oral lichen planus and oral lichenoid lesions: Diagnostic and therapeutic considerations. Oral
Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 103(Suppl S25):e1-e12.
• 573. Porter SR, Kirby A, Olsen I, Barrett W: Immunologic aspects of dermal and oral lichen planus. Oral Surg Oral Med Oral
Pathol 1997; 83:358-366.
• Do Prado RF, Marocchio LS, Felipini RC. Oral lichen planus versus oral lichenoid reaction: Difficulties in the diagnosis. Indian J Dent Res
[serial online] 2009 [cited 2016 Oct 11];20:361-4. Available from: http://www.ijdr.in/text.asp?2009/20/3/361/57375
• Kamath VV, Setlur K, Yerlagudda K. Oral Lichenoid Lesions - A Review and Update. Indian Journal of Dermatology. 2015;60(1):102.
doi:10.4103/0019-5154.147830.
REFERENCES

35. END OF
PRESENTATION
THANK YOU
FOR YOUR
ATTENTION!