Oral Lichen Planus is a common mucosal disease

1. ORAL LICHEN
PLANUS
ARSALAN WAHID MALIK

2. Oral Lichen Planus
Common mucocutaneous disease with varying
clinical presentation
Premalignant condition
Involvement of oral mucosa is frequent along
with or preceded by lesions on skin and genital
mucous membrane

3. Definition
 OLP is a rather common chronic mucocutaneous
disease which probably arises due to abnormal
immunological reaction and the disease have some
tendency to undergo malignant transformation

4. Lichenoid reactions
 Exhibits clinical and histological similarity
 Distinguished from OLP on the basis of
1. Association with administration of drug,
contact with a metal,
use of food flavors or systemic diseases
2. Resolution when the cause is eliminated or
when disease is treated

5. Epidemiology
 Very common- 1% of population
 In asians 1.5%(average)
3.7% mixed oral habits
0.3% non users of tobacco
 Risk more among who smoke and chew
tobacco
cutaneous lesion alone 35%
mucosal lesion alone 25%
both together 40%

6. Etiology
 Specific etiology is unknown
 Psychological stress
 No evident genetic base or no uniform etiologic factors
 Abnormal recognition and expression of basal
keratinocytes of epithelium as foreign antigens by
langerhans cells

7. Pathogenesis
CD8 + T cells trigger the apoptosis of oral
epithelial cells
They recognize an antigen which is similar to an
antigen associated with major histocompatability
complex class 1 on keratinocytes
They release cytokines that attract additional
lymphocytes which accumulate in sub basilar
connective tissue
Liquefaction degeneration of basal keratinocytes

8. Clinical Features
 Middle aged or elderly people
mean age of onset- 5th
decade of life
rarely in young adults and children
 More in females ( 1.4:1 )
Site- Both skin lesions and mucosal lesions are present

9. Skin Lesions
 Purple, pruritic and polygonal papules
 May be discreet or gradually coalesce into plaques
each covered by fine glistering scale
 Bilaterally symmetrical
 Increase in size if subjected to any irritation
 Usually self limiting unlike the oral lesions lasting only
one year or less

10. Skin Lesions
 Initially red > purple or violaceous hue > a dirty
brownish color
 Periods of regression and recurrence
 “Koebner’s phenomenon”- skin lesions extend along
the areas of injury or irritation
 Most often on wrist, forearms, knees, thighs and trunk
 Face remains uninvolved

11. Mucosal Lesions
 Normally asymptomatic
 Bilaterally symmetrical
 Sometimes simultaneously have OSF, leukoplakia,etc.
 Clinical types
1.reticular
2.atrophic
3.erosive
4.bullous
5. other types

12. Reticular type
 Most common and most readily recognized
form
 Slightly elevated fine whitish lines
(Wickham’s striae) in lace like or annular
pattern
 Lines are wavy and parallel
 A tiny elevated dot like structure at the point
of intersection of lines
 Commonly on buccal mucosa and buccal
vestibule

14. Atrophic type
 Keratotic changes
combined with mucosal
erythema
 smooth, poorly defined
erythematus areas with or
without peripheral striae
 Usually associated with
desquamative gingivitis
 Pain and burning
sensation

15. Erosive type
 Pseudo membrane covered ulcerations with
keratosis and erythema
 Severe form with extensive degeneration and
separation of epithelium from connective
tissue
 Pain, burning sensation, bleeding,
desquamative gingivitis
 Commonly on buccal mucosa and vestibule
 More dysplasia and malignant transformation

16. Bullous type
 Vesciculobullous presentation combined
with reticular or erosive pattern
 Rare form characterized by large vesicles
or bullae (4mm to 2cm)
 Lesions usually develop within an
erythematus base, rupture immediately
leaving painful ulcers
 Usually have peripheral radiating striae and
seen on posterior part of buccal mucosa

17. Other types
 Plaque type: flattened white areas
-dorsal surface of tongue
-often resemble leukoplakia
 Hypertrophic type: well circumscribed, elevated white
lesion resembling leukoplakia
-biopsy needed for diagnosis
 Pigmented type: rarely erosive type can be associated with
diffused erythema
-usually on buccal mucosa and vestibule
-reticulated white patches with or without a red erosive
component flanked brown macular foci

19. Histopathology
 Hyper orthokeratinisation or hyper
parakeratinisation
 Thickening of granular layer
 Acanthosis of spinous layer
 Intercellular oedema in spinous layer
 “Saw-tooth” rete pegs
 Liquefaction necrosis of basal layer
 Civatte ( hyaline or cytoid) bodies
 Juxta epithelial band of inflammatory
cells

21. Immunofluorescent Studies
 Band of fibrinogen in the
basement membrane zone
 Multiple IgM staining cytoid
bodies in dermal papilla or
peribasalar area
 Highly suggestive of lichen
planus if present in clusters

22. Differential Diagnosis
 Lichenoid reactions
 Leukoplakia
 Candidiasis
 Pemphigus
 Cicatricial pemphigoid
 Erythema multiforme
 Syphilis
 Recurrent aphthae
 Lupus erythematosus
 Squamous cell carcinoma

23. Malignant transformation
 Controversy
 Increased risk of oral squamous cell carcinoma
 Frequency of transformation is low, between 0.3% and 3%
 Erosive and atrophic forms commonly undergo
transformation

25. Treatment
 No cure
 Management of symptoms
 Principal aims: resolution of painful symptoms,
resolution of mucosal lesions, reduction of risk of
cancer & maintenance of good oral hygiene
 Corticosteroids: both systemic & topical
 Topical:
0.05% fluocinonide ( Lidex)
0.05% clobetasol ( Temovate)
as pastes or gels
 Candida overgrowth