- This document appears to be a medical report for a 42-year-old Filipino female patient presenting with carious teeth. - The clinical examination revealed a pigmented lesion on the buccal mucosa that was diagnosed as oral lichen planus based on its characteristics and histology. - Oral lichen planus is an autoimmune condition more common in middle-aged females. The patient's case was asymptomatic reticular type. Follow up was planned every 6 months to 1 year.

1. بسم الله الرحمن الرحيم Reham Al-haratani 300075

2. Demographic Data AGE : 42 years old NATIONALITY : Philipino GENDER : Female Chief Complaint: Wants to treat her carious teeth.

3. MEDICAL HISTORY: Rheumatoid Arthritis – Ankle Swelling.. “Voltaren” . Hypothyroidism. Episodes of headaches and fainting. 1996, inflammatory lymphadenitis..admitted for surgery. History

4. Extra-oral Examination:

5. Dental History: Bleeding gum. Several extractions. some fillings. TMJ dislocation. Family History: Cardiac arrest. Hypertension.

6. Clinical Examination GENERAL : Insignificant B . Extra-oral : Insignificant C. Intra-oral Examination : Pigmented lesion discovered. Otherwise, normal.

7. INTRA-ORAL EXAMINATION

8. d. Radiographic Findings

9. Description of lesion

12. So…regarding the buccal mucosa (lesion): -Location: Irregularly distributed, bilaterally. -Texture: Smooth.. Does not disappear upon rubbing nor stretching. -Color & Shape: Brown pigmentations + white striations (characteristic Wickham’s striae).

13. -Size: Brown pigm. All over. White striations extend from retromolar area up to the commissures. - Lingual gingiva of lower anterior teeth. -Painless - No discomfort upon eating nor swallowing.

14. lichen planus. (Reticular form) with areas of pigmentation. lichenoid reaction Physiologic pigmentation. Differential diagnosis

15. ORAL LICHEN PLANUS Reticular asymptomatic type.. FINAL DIAGNOSIS مرض الحزاز المنبسط الفموي

16. Thyroid Function Test to check the hormonal status : Results: Within normal range. Investigations done:

18. Last follow-up was on Sunday 8 - 4 - 2007 Showing stability without any progression Follow Up

19. Treatment Plan… Further follow up every 6 months - 1 year

20. Background: Autoimmune chronic mucocutaneuos condition. Age: middle-aged persons Gender: female predilection Etiology: T-cell-mediated autoimmune disease. Clinically: Types Reticular ASYMPTOMATIC Erosive (ulcerations) Atrophic (erythema) Bullous (blisters) SYMPTOMATIC – Pre-malignant About Lichen Planus

23. OLP associated with patchy brown melanin deposits 28 % have coincident skin lesions..polygonal papules with white lines on surface

24. HISTOLOGY: 1. Hyperkeratosis. 2. Acanthosis. 3. Saw-tooth Rete Ridges (shortened). 4. Basal cell degeneration (liquefaction). 5. Band-like lymphocitic infiltration.

25. Management : Asymptomatic type No pharmalogical intervention Symptomatic Corticosteroids Topical orabase Retinoids + biopsy and examination every 4-6 months.

26. Oral Lichen Planus and Hepatitis C and B viruses : is there a real association?

27. Aim : investigate occurrence of skin and oral LP in patients with CLD.. Info. : when 2003 where KAUH who Dr. Maha Abdel-salam Dr. Rabab Feteih

28. Methods Results 94 with CLD 78 HCV +ve HBV +ve OLP detected in 5 pts HCV +ve 1 HBV +ve 2. Biopsies obtained Confirmed the clinical diagnosis 3. Liver function tests Insignificantly associated 4. Statistical analysis, assess reliability of liver enz. to predict OLP Not predictive

30. Methods Results 94 with CLD 78 HCV +ve HBV +ve OLP detected in 5 pts HCV +ve 1 HBV +ve 2. Biopsies obtained Confirmed the clinical diagnosis 3. Liver function tests Insignificantly associated 4. Statistical analysis, assess reliability of liver enz. to predict OLP Not predictive

32. Methods Results 94 with CLD 78 HCV +ve HBV +ve OLP detected in 5 pts HCV +ve 1 HBV +ve 2. Biopsies obtained Confirmed the clinical diagnosis 3. Liver function tests Insignificantly associated 4. Statistical analysis, assess reliability of liver enz. to predict OLP Not predictive

33. Conclusion: OLP … an extrahepatic manifestation of CLD.. Comparison : when 1997 where Dammam Differences: 1. Participants diagnosed 1 st with OLP then CLD was studied.. 2. Claimed a correlation between liver enzymes and OLP

34. Main conclusion: OLP CLD Dentist Physician HCV and HBV screening results...

37. References : Abdel-salam M. , Feteih R. “Oral Lichen Planus in Patients With Chronic liver disease”. Egyptian Dental Journal, 49, 953 - 958, April, 2003. El-rifaei A., Fathalla S. “The Prevalence of Indices of HC and HB infection in Patients With OLP in Eastern Saudi Arabia”. Saudi Society of Family and Community Medicine,1997. Sugerman P. et al. “Oral Lichen Planus”.2005. www.e-medicine.com Neville B.W. et al. “Oral and Maxillofacial Pathology”.(2 nd edition), chp.16, pg 680-685..2003