What are the diagnosis and general management involved in Lichen Planus

The lesions of oral lichen planus appear, regress, and reappear in a somewhat unpredictable fashion.

Major researchers calculated that 41 percent of reticular lesions healed spontaneously whereas 12 percent of the atrophic, 7 percent of the plaque like lesions, and none of the erosive group healed without treatment.

Chronic oral lichen planus often loses the characteristic reticular feature, and atrophic and plaque like changes becomes more important.

Thorn and coworkers also confirmed that long-term topical steroid and antimycoctic therapy had no apparent effect on the course of the disease.

Lesions are usually too diffuse for surgical removal, although cryotherapy and cauterization have been used. Surgical excision also has a place in the treatment of long standing erosive lesions.

Symptomatic treatment of oral lesions can be provided by topical analgesics or anti histamane rinses, or more specifically by use of topical corticosteroids.

Topical corticosteroids promote healing of erosive areas but do not eliminate reticular popular or plaque like changes of lichen planus. Various corticosteroids have been used, including hydrocorticosone, prednisolone.

Prednisone, betamethasone and beclomethosone, triamcinolone and fluocinonide, applied in either gel, cream, oral solution or aerosol formulations.

Side effects of this treatment are minimal, and prolonged use of topical oral steroids without an occlusive dressing does not usually lead to any detectable adrenocortical auppression, other than in increased blood sugar level in known diabetics.

When applied unrestrictedly by the patient under a gingival stent or denture, however, absorption is greatly increased and may lead to clinical signs of adrenocortical suppression.

Candida overgrowth with clinical thrush may also develop, requiring concomitant topical or systemic antifungal therapy. Weekly intralesional injections of triamcinolone acetonide.

Triamcinolone diacetate, or other injectable hydrocortisone or prednisolone solution are useful in healing nonresponsive and extensively eroded areas of mucosa, the pain of the injection may be controlled by injecting the steroid in a 50 percent mixture with lidocaine.

No more than two or three injections are usually required and healing of the previously ulcerated site occurs in 5 to 7 days, if the injections are well spaced and encompass the entire lesion.

Retinoids are also useful, usually in conjunction with topical corticosteroids as adjunctive therapy for oral lichen planus.The lesions of oral lichen planus appear, regress, and reappear in a somewhat unpredictable fashion.

There is no specific treatment for lichen planus. In the past, such compounds as arsenicals, mercurials and bismuth were used, but with only indifferent success.

Although vitamin therapy has been advocated with some reported benefit, the value of such therapy is difficult to estimate. Corticosteroid therapy has been used in severe cases to relieve the inflammation and decrease the pruritus of skin lesions.

The intraoral lesions also respond to corticosteroids, especially intralesional administration. This is particularly indicated in the erosive form or when there is significant pain.

It is not uncommon for the disease to regress completely after stabilization of the emotional state of the patient.

Malignant potential:

Lichen planus, at one time, was thought to be a perfectly benign disease and was not considered a potentially premalignant condition. However, there has been a relatively large number of cases of epidermoid carcinoma developing in oral lesions of lichen planus reported in the literature.

In as much of both oral lichen planus and oral cancer are relatively common diseases, their simultaneous occurrence in the same patient at least in some cases may only be fortuitous.

Nevertheless, the possibility of a true relationship between these two diseases, albeit quite a limited one, must be accepted pending clarification through further study.

Interestingly and perhaps significantly, the majority of these reported cases of cancer have occurred in the erosive type of lichen planus. An analogous malignant transformation of dermal lichen planus has been reported but is very rare.



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