12 lichen planus
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Lichen Planusand Lichenoid Mucositis
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What is Lichen Planus
• Common, dermatologic disease• Often affects oral mucosa
• Flat lesions like lichens
• Immunologic disorder
• Lichenoid mucositis
• Association with hepatitis C
• Stress induced?
Clinical Features• Prevalence: 0.1%-2.0%
• Middle-aged adults
• Women
• Skin: Purple pruritic papules at the flexor
surfaces, Wickham’s striations
• Oral mucosa
– Reticular
– Erosive
Oral Lesions
• Reticular – Usually no symptoms
– Posterior buccal mucosa bilaterally
– Interlacing white lines (Wickham’s striae)
– Wax and wane
• Erosive – Symptomatic
– Atrophic erythematous areas
– Periphery: fine radiating striations
– Gingiva: desquamative gingivitis
– Bullous lichen planus
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Diagnosis
• Clinical features
– Reticular
– Erosive
• Incisional biopsy
– Parakeratosis, orthokeratosis, hyperkeratosis
– Thickness of spinous layer varies, “saw-tooth”
– Hydropic degeneration of basal cell layer
– Degenerative epithelial cells (Civatte bodies)
– No significant dysplasia
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Treatment
• Topical corticosteroids
• Systemic corticosteroids
• Cytotoxic medications
Malignant Potential of Lichen Planus
• Lichenoid dysplasia
• Chronic cases of lichen planus
– Erosive
– Long-standing
– <3.0%
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Desquamative Gingivitis
• Erosive lichen planus
• Cicatricial pemphigoid
• Pemphigus vulgaris
• Bullous pemphigoid
• Linear IgA disease
• Epidermolysis bullosa acquisita
• Systemic lupus erythematosus
• Chronic ulcerative stomatitis
• Paraneoplastic pemphigus
• Hormone mediated desquamative gingivitis
• Abnormal response to plaque
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Desquamative Gingivitis
• A clinical descriptive term• Most cases are pemphigoid or lichen planus
• Chronic ulcerative stomatitis: unresponsiveto steroids
• >40 years of age; females
• Gradual onset
• Facial gingiva
• Tx: Excellent DH; doxycycline monohydrate,topical corticosteroids, dapsone orsulfapyridine
Lichenoid Reaction to Dental
Materials
• Lichenoid gingivitis: after periodontal
curettage and polishing; placement of crowns
• Lichenoid reaction to amalgam
– Reaction to mercury or mercury compound (!?)
– Galvanic currents (not proven)
– Lesions directly in contact with the restoration
– Tx: Remove restoration and replacement with
composite, gold crown or PFM
Lichenoid Reaction to Medications
• Box 9.3; Page:348
• Work with the physician
• Immunofluorescence: Indirect method; IgG
reaction featuring “string of pearls” pattern;
basal cell cytoplasmic antibody.
Contact Stomatitis from
Artificial Cinnamon
• Gingiva: Plasma cell gingivitis
• Exfoliative cheilitis and perioral dermatitis
• Gum and candy: buccal mucosa and
lateral tongue
• Lesions look like frosting, or lupus
erythematosus-like, frictional
hyperkeratosis-like, hairy leukoplakia-like,
lichenoid
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Contact Stomatitis from
Artificial Cinnamon
• Histology
– Can be diagnostic (depends on who reads it)
– Similarities with lupus
Graft vs. Host Disease
• Recipients of allogeneic BMT
• HLA-matched donor
• Leukemia, aplastic anemia, metastatic disease
• Implanted cells attack tissues of the host
• Acute and chronic GVHD
• Mild rush to diffuse necrolysis
• Oral lesions: Sometimes only finding, lichenoid