Lichen Planus Review Article Text

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Medical treatment of oral lichen planus olp is essential for the management of painful, erythematous, erosive, or bullous lesions. The principal aims of current oral lichen planus therapy are the resolution of painful symptoms, the resolution of oral mucosal lesions, the reduction of the risk of oral cancer, and the maintenance of good oral hygiene. In patients with recurrent painful disease, another goal is the prolongation of their symptom free intervals. 28, 29, 30 the main concerns with the current therapies are the local and systemic adverse effects and lesion recurrence after treatment is withdrawn.

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Treat any sharp teeth or broken restorations or prostheses that are likely to cause physical trauma to areas of erythema or erosion by using conventional dental means. If the patient has an isolated plaquelike or erosive oral lichen planus lesion on the buccal or labial mucosa adjacent to a dental restoration, and if an allergy is detected by means of skin patch testing, the lesion may heal if the offending material is removed or replaced. However, most lichenoid lesions adjacent to dental restorations are asymptomatic. If systemic drug therapy eg, treatment with nsaids, antimalarials, or beta blockers is suspected as the cause of oral lichenoid lesions, changing to another drug may be worthwhile. However, the switch rarely resolves the erosions, and almost never resolves the white patches of oral lichen planus.

Inform all patients with oral lichen planus about their slightly increased risk of oral scc the most common of all oral malignancies. As with all patients, advise those with oral lichen planus that this risk may be reduced by eliminating tobacco and alcohol consumption and by consuming a diet rich in fresh fruits and vegetables, among other measures see complications. Erosive and atrophic lesions can be converted into reticular lesions by using topical steroids. Therefore, the elimination of mucosal erythema and ulceration, with a residual asymptomatic reticular or papular lesions, may be considered an end point of current oral lichen planus therapy. With respect to plaque lesions, the effect of treatment on the risk of oral cancer is unclear. The exact cause of lichen planus is unknown. it may be related to an allergic or immune reaction. Risks for the condition include: exposure to medicines, dyes, and other chemicals including gold, antibiotics, arsenic, iodides, chloroquine, quinacrine, quinide, phenothiazines, and diuretics diseases such as hepatitis c mouth sores are one symptom of lichen planus.

They: may be tender or painful mild cases may not cause pain are located on the sides of the tongue, inside of the cheek, or on the gums look like bluish white spots or pimples form lines in a lacy network gradually increase in size sometimes form painful ulcers current data suggest that oral lichen planus is a t cell–mediated autoimmune disease in which autocytotoxic cd8 + t cells trigger apoptosis of oral epithelial cells. 1, 2, 3 the dense sub epithelial mononuclear infiltrate in oral lichen planus is composed of t cells and macrophages, and there are increased numbers of intra epithelial t cells. Most t cells in the epithelium and adjacent to the damaged basal keratinocytes are activated cd8 + lymphocytes.

Therefore, early in the formation of oral lichen planus lesions, cd8 + t cells may recognize an antigen associated with the major histocompatibility complex mhc class i on keratinocytes. After antigen recognition and activation, cd8 + cytotoxic t cells may trigger keratinocyte apoptosis. Activated cd8 + t cells and possibly keratinocytes may release cytokines that attract additional lymphocytes into the developing lesion. 2 oral lichen planus lesions contain increased levels of the cytokine tumor necrosis factor tnf –alpha. 4, 5 basal keratinocytes and t cells in the subepithelial infiltrate express tnf in situ. 6, 7 keratinocytes and lymphocytes in cutaneous lichen planus express elevated levels of the p55 tnf receptor, tnf ri. 10, 11, 12, 13 tnf polymorphisms have been identified in patients with oral lichen planus, and they may contribute to the development of additional cutaneous lesions.

17, 18 together, these data implicate tnf in the pathogenesis of oral lichen planus. The lichen planus antigen is unknown, although it may be a self peptide or altered self peptide , in which case lichen planus would be a true autoimmune disease. The role of autoimmunity in the pathogenesis is supported by many autoimmune features of oral lichen planus, including its chronicity, onset in adults, predilection for females, association with other autoimmune diseases, occasional tissue type associations, depressed immune suppressor activity in patients with oral lichen planus, and the presence of autocytotoxic t cell clones in lichen planus lesions. The expression or unmasking of the lichen planus antigen may be induced by drugs lichenoid drug reaction , contact allergens in dental restorative materials or toothpastes contact hypersensitivity reaction , mechanical trauma koebner phenomenon , viral infection, or other unidentified agents. 19, 20, 21 this journal feature begins with a case vignette highlighting a common clinical problem.

Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. A 53 year old woman presents with intensely itchy skin lesions and burning in her mouth, which makes eating difficult. These signs and symptoms have become progressively evident during the past several weeks. Examination of her skin and oral cavity reveals violaceous, polygonal papules, mainly on the flexural aspect of the wrists and ankles and in the lumbar region, as well as erosions associated with a lacelike, white line network apparent in the posterior buccal mucosa. How should this case be managed? lichen planus is a mucocutaneous inflammatory disease of unknown origin. 1 other mucous membranes including the genitalia, esophagus, and conjunctiva and skin appendages e.g. 2 the clinical presentation of lichen planus varies depending on the area involved 3 5 figure 1a through 1f figure 1 clinical presentations of lichen planus.

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And table 1 table 1 typical symptoms and particular patterns of lichen planus, with possible outcomes and complications. Cutaneous lichen planus is characterized by flat topped, violaceous papules figure 1a and 1b , the appearance of which may cause embarrassment 1 and which in some cases can be intensely itchy. The lesions may result in long standing residual hyperpigmentation, especially in dark skinned patients. 1,6 less common variants of cutaneous disease are shown in the figure in the supplementary appendix. Oral lichen planus is characterized by symmetric reticular lesions that resemble a white, lacelike network, as well as by papules, plaques, erythematous lesions, and erosions figure 1c 7 it is a chronic disease, and its erosive form is painful. 3,4 the clinical characteristics of anogenital lichen planus figure 1d and 1e are typically similar to those of both the cutaneous and the oral forms.

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