Oral lichen planus

Latest articles from "Ear, Nose & Throat Journal":

Transoral approach to a deep-lobe parotid tumor(October 1, 2014)

Submental nodular fasciitis: Report of an unusual case(October 1, 2014)

Basal cell carcinoma of the external auditory canal(October 1, 2014)

Giant-cell tumor of the tendon sheath in the external auditory canal(October 1, 2014)

Endoscopic view of an ostium in a concha bullosa of the superior turbinate(October 1, 2014)

Salivary gland choristoma of the middle ear(October 1, 2014)

Fish bone impaction in the supraglottis(October 1, 2014)

Other interesting articles:

Evaluating Relationships between Spatial Heterogeneity and the Biotic and Abiotic Environments
The American Midland Naturalist (April 1, 2010)

Long-Standing Erosion Calculator: Enters 21st Century
Agricultural Research (April 1, 2012)

Spatial variability of surficial sediments on the northern shelf of the Alboran Sea: the effects of hydrodynamic forcing and supply of sediment by rivers/Variabilidad espacial de los sedimentos superficiales en la plataforma septentrional del Mar de Alborán:influencia del régimen hidrofinámico y del aporte fluvial de sedimentos
Journal of Iberian Geology (July 1, 2011)

The recorded evidence of AD 1755 Atlantic tsunami on the Gibraltar coast/Las evidencias registradas del tsunami atlántico de 1755 en la costa de Gibraltar
Journal of Iberian Geology (July 1, 2011)

Canadian Social Science (March 1, 2011)

Taphonomic analysis of fossil concentrations from La Manga Formation (Oxfordian), Neuquén Basin, Mendoza Province, Argentina/Análisis tafonómico de las concentraciones fósiles de la Formación La Manga (Oxfordiano), Cuenca Neuquina, Provincia de Mendoza, Argentina
Journal of Iberian Geology (January 1, 2010)

Mouthwashes and their effect on global health
Canadian Journal of Dental Hygiene (August 1, 2011)

Publication: Ear, Nose & Throat Journal
Author: Thompson, Lester D R
Date published: March 1, 2012
Language: English
PMID: 37298
ISSN: 01455613
Journal code: ENTJ

Lichen planus (LP) is a chronic, self-limited, inflammatory disorder of unknown etiology that involves mucous membranes, skin, nails, and hair. It is postulated that there is an abnormal T-cell-mediated immune response that results in disruption of the basement membrane. Several drugs are known to be associated with the onset of LP, but the exact mechanism is unknown.

LP develops in about 1 to 2% of the general population, with a peak in middle-aged adults and with women affected more often than men (3:2). Three major types are recognized in the oral cavity: reticular, erosive, and bullous.

Reticular LP is usually asymptomatic, affects multiple sites, and can be recognized by white papules that can coalesce to form plaques.There may be fine, white, lace-like striae (Wickham striae) on the buccal mucosa, gingiva, and lips. Cutaneous LP may be seen in up to 44% of patients with oral LP. Erosive LP usually presents with pain while eating, especially with spicy foods. There is usually atrophic, erythematous mucosa with ulcerations. Bullous LP is uncommon, resulting in bullae formation with epithelial separation. This type may show a positive Nikolsky sign.

Treatment varies depending on the specific type of LP, usually including topical or systemic corticosteroids and topical antifungal agents. Symptoms usually come and go over the patient's lifetime, requiring lifelong therapy or monitoring after the initial presentation.

Histologically, the lesions usually show both atrophy and acanthosis of the squamous epithelium, with variable degrees of both ortho- and parakeratosis. The classic appearance is a "sawtooth" pattern to the rete, with a hydropic degeneration of the basal layer (figures 1 and 2). A rich, band-like, predominantly T-cell IymFrom phocytic infiltrate results in blurring of the epithelialto-stromal junction.

Plasma cells may also be seen. Isolated, degenerated keratinocytes (Civatte, or hyaline, bodies) are present at the epithelial-stromal junction (figures 2 and 3). Erosive LP may show ulceration or a sub-basal separation of the epithelium from the stroma. It is not uncommon to have a secondary, superimposed candidiasis. Direct immunofluorescence of perilesional tissue may show linear or granular deposits of fibrin or fibrinogen (figure 2). Importantly, there is no dysplasia, although reactive atypia may be present.

The pathology differential diagnosis for lichen planus includes mucous membrane pemphigoid, pemphigus vulgaris, lichenoid reaction to drugs, lupus erythematosus, chronic graft-versus-host disease, linear IgA disease, and cinnamon-induced stomatitis.

Suggested reading

Eisen D. The clinical features, malignant potential, andsystemic associations of oral lichen planus: A study of 723 patients. J Am Acad Dermatol 2002;46(2):207-14.

Kulthanan K, et aL Direct immunofluorescence study in patients with lichen planus. Int | Dermatol 2007;46( 12): 1237-41.

McCartan BE, et al. The reported prevalence of oral lichen planus: A review and critique. J Oral Pathol Med 2008:37(8):447-53.

Müller S. Oral manifestations of dermatologie diseases: A focus on lichenoid lesions. Head Neck Pathol 2011:5:36-40.

Scully C et al Oral mucosal disease: Lichen planus. Br J Oral Maxillofac Surg 2008:46(1):15-21.

Author affiliation:

Lester D.R. Thompson, MD

Author affiliation:

From the Departmeot of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, Woodland Hills, Calif.

The use of this website is subject to the following Terms of Use