What are the clinical symptoms in Lichen Planus

Apart from the erosive and bullous forms of the disorder, lichen planus is quite frequently an indolent.

Painless lesion that many times has been present in a patient’s mouth long before it is recognized during a routine dental examination or by the patient noticing that the check or lip mucosa is rougher than usual.

The clinical features of the lesions in a given patient often vary with time, both in terms of the morphology of the clinical lesion and its extent and the area of erosion of the atrophic mucosa.

The reticular form consists of slightly elevated, fine, whitish lines that produce either a lacelike lesion, a pattern of fine radiating lines, or annular lesions.

This is the most common and most readily recognized form of lichen planus, and the only form notd in more than one of the population surveys reported over the past 30 years.

Most patients with lichen planus at sometime exhibit some areas of the reticular form. The cheeks and tongue are preferentially affected in many patients with lichen planus, the lips, gingivae, floor of the mouth, and palate are less frequently involved.

Because reticular lesions are the most common form, they are seen most often on the cheek and tongue, in many cases as bilateral lesions.

In the popular form, 0.5 to 1mm whitish elevated lesions, or papules, are usually seen on the well keratinized areas of the oral mucosa, but large plaque like lesions that are often difficult to distinguish from leukoplakia may occur on the cheek, tongue and gingivae.

Papular, plaques like, atrophic and erosive lesions are very frequently accompanied by reticular lesions. A search for these is an essential part of the clinical evaluation of a patient with suspected lichen planus, and when biopsy provides only a non-specific diagnosis (e.g., acute and chronic inflammation).

The diagnosis of lichen planus is often confirmed by identifying an area of reticular pattern, even though at times only a small flame like patch or radially arranged white lines is found.

Characteristically, the affected areas of the oral mucosa are not bound down or rendered inelastic by lichen planus, and the keratotic white lines cannot be eliminated either by stretching the mucosa or rubbing its surface.

Reticular and popular lesions are generally asymptomatic, atrophic, erosive and bullous forms are generally associated with pain.Atrophic lichen planus involving the gingivae is often referred to as desquamative gingivitis.

A descriptive clinical term used for bright red, edematous patches involving the full width of the attached gingivae, which must be distinguished histologically from similar lesions occurring in some patients with mucous membrane pemphigoid and pemphigus.

An association has been described between oral lichen planus, diabetes mellitus and hypertension. This triad is referred to as grinspan’s syndrome and has been suggested as predisposing to the development of squamous cell carcinoma.

Subsequent investigation of other series of patients with lichen planus have not confirmed grinspan’s finding, other than that a proportion of patients with chronic oral problems especially those attending hospital clinics will be found to have diabetes and hypertension.

Lichen planus has also been described in association with autoimmune diseases.Three features are considered essential for the histopathologic diagnosis of lichen planus, areas of hyperparakeratosis or hyperorthokeratosis,

Often with thickening of the granular cell layer and a saw tooth appearance to the rate pegs, liquefaction degeneration or necrosis of the basal cell layer, which is often replaced by an eosinophilic band, and a dense subepithelial band of lymphocytes.

The main diagnostic feature that lichen planus shares with other lichenoid reactions is damage to the basal cell layer, including both vacuolar changes and cell death.

Vacuolar change is characterized by intra-cellular vacuolar, edema, separation of basal cells, and detachment of the lamina propria from the basal cells.

Artifactual tears at this level are often seen in specimens mounted for light microscopy, raising the possibility of a vesiculobulous lesion, and bullae develop at this level in bullous lichen planus.

The epidermal cell death noted in this disorder usually involves single basal cells, which are shrunken with eosinophilic cytoplasm and one or more pyknotic nuclear fragments.

These dead cells are referred to as Civatte bodies, and there is ultrastructural evidence that they develop by a process of apoptosis, by which cells are converted to filamentous bodies that are phagocytosed by macrophages or adjacent basal cells.

Apoptosis eveokes little inflammatory reaction, compared with cell death by necrosis, and the cells undergoing apoptosis in the basal layers of lichenoid ipithelium are elsewhere often referred to as dyskeratotic cells.



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