Lichen planus is a chronic inflammatory skin and mucous membrane disease characterized by violaceous papules that may form plaques. Oral lichen planus commonly presents as striae - sharply defined white lacy patterns - but can also be erosive, atrophic, or bullous. CD8 T cells trigger apoptosis of oral epithelial cells. Treatment aims to reduce symptoms, resolve lesions, and prevent oral squamous cell carcinoma through topical corticosteroids, systemic medications, surgery or laser, with complications including infection and malignant transformation requiring careful long-term follow-up.
3. Lichen Planus is
common chronic inflammatory disease
of skin and mucous membrane
presence of cutaneous violaceous
papules that may coalesce to form
plaques
6. Erosive
shallow irregular area of epithelial destruction
very persistent and may be covered by smooth,
slightly raised yellowish layer of fibrin
margins may be slightly depressed due to fibrosis
and gradual healing at the periphery
striae may radiate from the margins of these
erosions
12. CD8 T cell trigger the apoptosis of oral epethelium cell
These cells become cytotoxic for basal keratinocytes
Liquefaction degeneration of basal keratinocytes
14. Immune system has a primary role in the
development of this disease
Predisposing factor
Genetic background
Dental material
Drugs
Infectious agent
Habits
Trauma
Diabetes and hypertension
Stress
Miscellaneous associations
16. CLINICAL FEATURES:
Patients usually over 40 years ,Children are rarely
affected
Females account for at least 65% of patients
Untreated disease can persist for 10 or more
years
Common sites are:
Buccal mucosae
Dorsum of tongue
Gingivae (infrequently)
Lip(mucosal side
Posterior buccal mucosa ( most common site )
17. Lesions usually bilateral and often
symmetrical Cutaneous lesions only
occasionally associated
Striae alone may be asymptomatic, but
atrophic lesions are sore and erosions cause
more severe symptoms
Eating becomes difficult
22. Liquefaction degeneration
of the basal cell layer
Compact, band-like
lymphoplasmacytic
(predominantly T-cell)
infiltrate cells hugging the
epithelio-mesenchymal
junction
CD8 lymphocytes
predominate in relation to
the epithelium
Basal cell degeneraton
Infiltration of lymphocytes
24. No treatment for oral lichen planus is
curative
Goal:
• Reduce painful symptoms
• Resolution of oral mucosal lesion
• Reduce risk of Oral SCC
• Improve oral hygiene
• Eliminate exacerbating factor
• Diet
• Reduce stress
25. • Medication:
o Topical corticosteroid
o Systemic corticosteroid
o cyclosporin
o Griseofulvin
o Retinoids
o Prophylactic use of 0.12%
Chlorhexidine mouthwash
• Surgery
• laser
• photochemotheraphy
26. Complication
1.OLP and its treatment may predispose
people to oral candida albicans super
infection.
2. Malignant Transformation: Reported
transformation rates vary from 0.5 to 2%
over a period of 5 years. -Erosive and
atrophic forms commonly undergo
transformation.
3. Oral SCC in patients with OLP is a
controversial issue.
28. Particulars of patient
•Name- Mrs. Salina
•Age-45 y
•Sex -female
•Reg no-3492/130
•Address-Mirpur 10, Dhaka
Chief complaint
•Burning sensation in the mouth for 6 months
H/o present illness
• According to the statement of the patient she was
reasonably well 6 months back. Then she developed
burning sensation in the mouth for last 6 months while
consuming spicy food and bilateral pigmentation on the
inner part of cheek. She is diabetic. Now she admitted to
DDCH for better management.
29. Intraoral examination
On intraoral examination, a greyish brown patch with white
striae were observed in the posterior buccal mucosa
extending into retromolar fossa. Lesions are non tender on
palpation. No other mucosa or skin surface showed lesional
change
Diagnosis
Oral lichen planus
Treatment
• Scaling
• Oral hygiene maintain
• Trialon ointment
• Mouthwash
30.
31. Oral lichen planus is a complex and poorly
understood clinical condition which can not be
cured. A definitive diagnosis and careful,
conscientious follow-up are imperative..Symptoms
and complications are common and challenging
but may be managed with a variety of therapies
including orally administered and systemic
medications as well as lifestyle alterations and
reduction of precipitating factors.
Conclusion