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

Diplopia: An uncommon presentation of silent sinus syndrome(July 1, 2015)

On the appropriateness of norm- and criterion-referenced assessments in medical education(July 1, 2015)

Salivary gland adenoid cystic carcinoma(July 1, 2015)

A rare case of malignant fibrous histiocytoma (pleomorphic undifferentiated sarcoma NOS) of the vocal fold(July 1, 2015)

Erratum(July 1, 2015)

Fetal rhabdomyoma of the tongue in a newborn(July 1, 2015)

Intratympanic membrane congenital cholesteatoma(July 1, 2015)

Other interesting articles:

New insights about the Upper Jurassic - Lower Cretaceous sedimentary successions from Asturias (NW Iberian Peninsula)
Journal of Iberian Geology (January 1, 2014)

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

SOME GEOMORPHOLOGIC ASPECTS ALONG THE TIMIS RIVER IN THE ROMANIAN SECTOR/geomorphologische Aspekte entlang des Timis-Flusses im rumänischen Abschnitt/Aspecte geomorfologice de-a lungul albiei Timisului, în sectoral românesc
Transylvanian Review of Systematical and Ecological Research (January 1, 2013)

Vegetation History in the Oukaïmeden Valley. Human Action and the Evolution of the Landscape/Historia vegetal del Valle de Oukaïmeden. Acción humana y evolución del paisaje
Complutum (July 1, 2014)

Archaeological Interventions. In Search of Traces of the Human Presence in the Valley/Intervenciones Arqueológicas. A la búsqueda de las huellas de la presencia humana en el valle
Complutum (July 1, 2014)

Investigation on Fitting Method of Snail Structural Lines
Advances in Natural Science (January 1, 2015)

Dental Erosion: Diagnosis, Risk Assessment, Prevention, Treatment
Canadian Journal of Dental Hygiene (February 1, 2015)

Publication: Ear, Nose & Throat Journal
Date published:
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