What is Lichen Planus

Lichen Planus
and Lichenoid Mucositis

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Common, dermatologic disease

Often affects oral mucosa
Flat lesions like lichens
Immunologic disorder
Lichenoid mucositis
Association with hepatitis C
Stress induced?

Oral Lesions

Clinical Features
Reticular

Prevalence: 0.1%-2.0%
Middle-aged adults
Women
Skin: Purple pruritic papules at the flexor
surfaces, Wickhams striations
Oral mucosa
Reticular
Erosive

Usually no symptoms
Posterior buccal mucosa bilaterally
Interlacing white lines (Wickhams striae)
Wax and wane

Erosive
Symptomatic
Atrophic erythematous areas
Periphery: fine radiating striations
Gingiva: desquamative gingivitis
Bullous lichen planus

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

Treatment
Topical corticosteroids
Systemic corticosteroids
Cytotoxic medications

Malignant Potential of Lichen Planus

Lichenoid dysplasia
Chronic cases of lichen planus
Erosive
Long-standing
<3.0%

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

Desquamative Gingivitis
A clinical descriptive term
Most cases are pemphigoid or lichen planus
Chronic ulcerative stomatitis: unresponsive
to steroids
>40 years of age; females
Gradual onset
Facial gingiva
Tx: Excellent DH; doxycycline monohydrate,
topical corticosteroids, dapsone or
sulfapyridine

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

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