Oral Lichen Planus

Oral Lichen Planus

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  lichen lichen lichen
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  introduction epidem “Orallichen planus is a chronic immunologic inflammatory mucocutaneous disorder commonly found in oral cavity, where it appears as white, reticular, plaque or erosive lesions.” Erasmus Wilson, 1869 ٭ Symptomatic oral lichen planus is painful and complete healing is rare
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  epidemiology ٭ Prevalence- 1.27 % ٭ More frequent in women ٭ Age: 30 - 60 yrs ٭ Malignant potential is less than 1% clinica
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  clinical appearance Presentswith various manifestation such as ٭ Reticular ٭ Papular ٭ Plaque ٭ Atrophic ٭ Ulcerative ٭ Bullous
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  clinical appearance reticularpapular plaque atrophic ulcerative bullous ٭ Most common ٭ Usually asymptomatic ٭ Appears as a network of overlapping white striae ٭ Commonly seen bilaterally in buccal mucosa, tongue, gingiva, mucobuccal fold or multiple sites
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  clinical appearance reticularpapular plaque atrophic ulcerative bullous ٭ Usually present in the initial phase of the disease ٭ Clinically characterized by small white dots ٭ Most occasion which intermingle with reticular form
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  clinical appearance reticularpapular plaque atrophic ulcerative bullous ٭ Seen as a homogenous well demarcated white plaque ٭ Most common in smokers ٭ On cessation of smoking plaque may disappear and convert to reticular type ٭ Resemble homogenous oral leukoplakia ٭ Simultaneous presence of reticular or papular structures in case of plaque like oral lichen planus
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  clinical appearance reticularpapular plaque atrophic ulcerative bullous ٭ Characterized by homogenous red area ٭ Commonly associated with desquamative gingivitis ٭ Requires a histopathologic examination in order to arrive a diagnosis
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  clinical appearance reticularpapular plaque atrophic ulcerative bullous ٭ Most disabling of lichen planus ٭ Clinically – fibrin coated ulcers surrounded by an erythematous zone frequently displaying radiating white striae ٭ Sub epithelial inflammation - most prominent at center of the lesion ٭ Smarting sensation in conjunction with food intake
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  clinical appearance reticularpapular plaque atrophic ulcerative bullous ٭ Small bullae or vesicles that rupture easily, leaving painful, ulcerated surface
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  etiopathogenesis Current datasuggest that OLP is a T- cell mediated autoimmune disease in which auto-cytotoxic CD8 T-cells trigger apoptosis of oral epithelial cells To date, a specific antigen responsible for the develop of OLP remains un-identified
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  etiopathogenesis The restof the epithelium appears to react with thickening of spinous layer (acanthosis) and granular cell layer (parakeratosis or orthokeratosis) The rete ridges adopt a ‘saw tooth configuration’
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  diagnosis Oral manifestationof OLP maybe sufficient to make a correct diagnosis However, oral biopsy with histopathological evaluation is recommended to confirm the clinical diagnosis, and to exclude the dysplasia and malignancy (Scully, 2008)
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  medicines given ٭Steroids  Betamethasone  Clobetasol  Dexamethasone  Triamcinolone ٭ Calcineurin inhibitors  Tacrolimus  Cyclosporin  Pimecrolimus ٭ Retinoids ٭ Photo chemotherapy ٭ Newer traditional medicine – Aloe Vera treatm
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  Various treatment regimenshave been attempted to improve the lesions and reduce the associated pain, but a cure for OLP has not yet been accomplished because of its recalcitrant nature.
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  treatment protocol asymptomatic follow up – 3 month symptomatic check for candidiasis biopsy positive antifungal therapy no response no response systemic steroids response response follow up ? • improve oral hygiene • avoid precipitating factors (drugs, foods, chemicals) • reassurance topical steroids triamcinolone acetonide betamethasone tacrolimus candida positive follow up refere
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  thank you