Lichen
Planus
Lichen
Planus is a relatively common dermatosis that occurs on the skin and oral mucous
membrane. Lesions may be restricted to either location or may occur on both locations
in one patient.
About 50% of patients who have oral lichen Planus also
have skin lesions. The skin lesions are relatively constant, flat violacceous
papules with a fine scaling on the surface they may manifest in as many as six
different forms, often with more than one form of the lesion evident in one patient.
Because some lesions of oral lichen Planus are erosive and other bullous,
The etiology of lichen Planus involves a cell mediated, immunologically induced
degeneration of the basal cell layer of the epithelium.
Lichen Planus
is one variety of a broader range of disorders in which an immunologically induced
lichenoid lesion is the common denominator.
Thus, there are many clinical
and histological similarities between Lichen Planus and lichenoid dermatosis and
stomatitides associated with drugs.
Some autoimmune disorders, graft
versus host reaction and some forms of lymphoma. Although Lichen Planus may manifest
as a particularly well-defined and characteristic lesion, the differential diagnosis
for its lesions is quite extensive.
Lichen
Ruber Planus
It
is of particularly interested to the dentist because involvement of the oral mucous
membranes so frequently accompanies or precedes the appearance of lesion on the
skin, it is one of the most common dermatologic diseases to manifest itself in
the oral cavity and, therefore should be completely familiar to the dentist, particularly
since the diagnosis can often be established with out a biopsy.
Clinical
Features
The
skin lesions of Lichen Planus appear as small , angular, flat topped papules only
a few millimeters in diameters. These may be discrete or gradually coalesce in
to larger plaques, each of which is covered by a fine, glistening scale.
The papules are sharply demarcated from the surrounding skin. Early in the
course of the disease the lesions appear red, but they soon take on a reddish
purple or violacceous hue . Later a dirty brownish color develops.
The
center of the papule may be slightly umbiliated. Its surface is covered by characteristic
, very fine grayish white lines, called Wickham’s striae it may occurs anywhere
on the skin surface, but usually are distributed in a bilaterally symmetrical
pattern.
Most often on the flexor surface of the wrist and forearms,
the inner aspect of the knees and thighs. In chronic cases, hyper tropic plaques
may develop , especially over the shins. The primary symptom of Lichen Planus
is a serve pruritus that may be intolerable.
Lichen
Planus is a disease of adulthood, but occasionally children are affected. It is
without a dramatic sex predilection in its occurrence, although females are affected
somewhat more often than males in most reported series of cases.
The
etiology of Lichen Planus is not know it is interesting to note that the disease
seldom is seem in carefree persons. The nervous, high-strung person is almost
invariably the one in whom the conditions develops.
The Course of the
disease is long, from months to several years, frequently undergoing periods of
remission followed by exacerbations which often corresponds to periods of emotional
upset, over work, anxiety or some form of mental strain. Other causes suggested
include traumatism.
The presence of immunoglobulins and complement has
been reported at the epidermal dermal junction of skin cases of Lichen Planus,
thus suggesting a possible immune factors in the disease, Hoe ever this was far
less conclusive in the oral Lichen Planus of Daniels and Quadra white and of Walker.
An interesting
association of Lichen Planus, diabetes mellitus and vascular hypertension as been
described by Grinspan, the triad being described as Grinspan’s syndrome by
Grupper. However, in a group of over 120 patients with oral Lichen Planus.
Christensen and his co workers could find neither a relationship to hypertension
as based on arterial pressure, nor any difference between the glucose tolerance
of these patients and that of general population samples.
In additions.
Lichen Planus has been reported in several members on one family, raising the
question of hereditary patterns. There is no sound evidence for this idea, however
the majority of patients with dermal.
Lichen Planus have associated oral
lesions of the disease, according to the study of 115 patients with oral Lichen
Planus by andreasen, only 44% had skin lesions as well.
In oral Lichen
Planus female are also affected more frequently than, ales. In the study of 326
such patients reported by Kovesi , 63% were women, while of 200 patients reported
.Similar to those with were between 40 and 70years ages
| What
are the clinical symptoms in Lichen Planus | Diagnosis
and general management involved in Lichen Planus |
