CC Sept 2015 Oral Lichen Planus

echoecho's version from 2015-10-20 02:05


Question Answer
Define oral lichen planus?an immunologically-mediated mucocutaneous disease
It is more common in what gender? women to men ratio is (1.4 to 1)
Presents in what decades of life?3rd to 7th decades
Lesions are most commonly found on the ____ _____ (80%); and ____ (65%, with < 10% involving what?1) buccal mucose 2) tongue 3) palte or floor of the mouth
List the 3 main types of lichen planus?1) reticular (most common and can be seen in cominations w/ the other typs 2) Erythematous / atrophic and erosive
Are lesions usually bilateral or unilateral? Is distribution asymmetrical or symmetrical? bilateral ; symmetric
What does reticular lichen planus look like?it presents with a lacy white pattern (Wickham striae) on the mucosa. It is usually asymptomatic
Compare the different types of reticular lichen planus?1) erythematous type presents in combination with the reticular type (red patches are actually areas of atrophy between the white reticular lesions). 2) erosive type has ulcers and erosions and most commonly occurs with he reticular and erythematous lesions
The erythematous and erosive types are usually symptomatic with what symptoms?burning, irritation and pain
The isolated reticular type is found in only ____% of cases?25
List the extraoral 4 manifestations of oral lichen planus?1) cutaneous 2) genital 3) scalp 4) nails
Describe the cutaneous s/s of oral lichen planus?1) presents with the 6 Ps (pruritic, polygonal, planar or flat-topped, purple papules and plaques) 2) 60% of patients with cutaneous lesions will have oral lesions 3) several forms (annular, linear, atrophic, hypertrophic, vesiculobullous, errosive/ulcerative
Describe the genital s/s of oral lichen planus?1) more common in men; annular lesions most common 2) affects 25% of women with oral lesions (1/2 of genital cases are undiagnoseIsd) 3) in women, all 3 types can occur; can presents with itching or pain and can be associated with dysuria and dyspareunia
Describe the scalp s/s of oral lichen planus?lichen planopilaris (violaceous, pruritic, scaly, atrophic plaques). If untreated can lead to scarring alopecia
Describe the nails s/s of oral lichen planus?1) trachyonychia (longitudinal ridging and grooving) 2) also cuticular overgrowth, subungual hyperpigmentation and keratosis, thinning of nail bed, shedding of nail plate with atrophy of nail bed
What is the pathogenic mechanism for development of oral ichen planus?unknown, though it could be an autoimmune process. Other proposed mechanisms are trauma, infections, drugs, stress, contact allergens (dental materials) and genetic predisposition (HLA-A3)
Oral lichen planus with what viral infection (particularly in Japan and the Mediterranean area)?hepatitis C
Routine screening for hepatitis C in patients with oral lichen planus is _____?controversial
List the medications implicated in the initiation or exacerbation of oral lichen planus?1) NSAIDs 2) ACEI like lisinopril (Prinivil) 3) sulfonylureas like glipizide (Glucotrol), glyburide (Micronase) 4) beta blockers like propranolol (Inderal) 5) methyldopa (Aldomet) 6) quinidine 7) penicillamine 8) lithium 9)quinine 10) carbamazepine (Tegretol) 1) anti-retroviral drugs
What is the natural hx of oral lichen planus?1) includes episodes of remission 2) 40% undergo sponatenous remission but this is most likely with the isolated reticular type 3) There is a risk of malignant transformation (5%) particularly with the erythematous and erosive types
Does asymptomatic reticular lichen planus require treatment?no
List the nonpharmacologic interventions?1) good oral hygiene 2) smoking cessation 3) elimination of any mechanical or chemical irritation 4) avoidance of certain food types (spicy, acidic) if they seem to exacerbate symptoms
*** First-line pharmacologic therapy for symptomatic cases is?topical moderate to high potency corticosteroids (like beta methasone propionate, clobetasol, fluocinonide). Response rates approach 75% compared to placebo
*** Second-line therapy that is also very effective which includestopical calcineurin inhibitors (like pimecrolimus (Elidel), tacrolimus (Protopic)
Intralesional steroid injetions have been used with good success for what type of lesions?erosive
Topical cyclosporine have shown some benefit in small trials, true or false?true
Systemic steroids are reserved for what type lesions?severe, wide spread lesions not responsive to other therapies
List other interventions used that do not have good evidence supporting their use?1) laser evaporation 2) PUVA (psoralen, ultraviolet A) 3) cryotherapy 4) dapsone 5) topical retinoids 6) methotrexate
How does oral candidiasis present? What is the treatment?1)with white plaques and patches on the tongue and buccal mucosa rather than the fine reticular pattern of lichen planus 2) antifungals
Define geographic tongue (benign migratory glossitis)? Are white lesions present? 1)results from arcs of normal or hyperplastic filiform papillae in a "map-like" pattern bordering erythematous areas of atrophied (denuded) filiform papillae. 2) no
Describe Behcet's syndrome?aphthous ulcerations that are painful, are usually associated with other mucocutaneous lesions, typically resolving in several weeks
Describe leukoplakia?appears as single or multiple white patches or plaques (not a reticular pattern) that can progress to malignancy
*** Summary Oral lichen planus is more common in what gender? and in what decade of life?women; 3rd to 7th decades of life
*** Summary lesions most commonly found where?buccal mucosa and tongue
*** Summary often associated with extra-oral manifestations, name a few?rash, skin lesions, genital lesions
*** Summary Can medications be an inciting factor?yes
*** Summary First-line therapy is what?moderate to high-potency steroids