24 Questions
What is the characteristic appearance of the rete pegs in Lichen Planus?
Saw-toothed appearance
What is the term for the necrosis of the basal cell layer in Lichen Planus?
Liquefaction degeneration
What is the primary function of Langerhans cells in the epithelium?
Antigen presentation
What is the characteristic histopathological feature of classical Lichen Planus?
Dermal band-like infiltrate of lymphocytes and macrophages
What is the term for the small clefts seen at the dermal-epidermal junction?
Caspary-Joseph spaces
What is the term for the shrunken cells with pyknotic nuclear fragments seen in the epithelium?
Civatte bodies
In Papular Lichen Planus, what is the characteristic feature of the stratum corneum?
Increase in width
What is the mechanism of cell death of basal cells by T-lymphocytes?
Both cytotoxic effect and apoptosis
What is the main characteristic of bullous OLP?
Development of vesicles or bullae
What is the chief complaint of patients with ulcerative lichen planus?
Pain that interferes with function and quality of life
What is the characteristic feature of desquamative gingivitis in lichen planus?
Bright red edematous patches with marked edema
What is the relationship between the magnitude of subepithelial inflammation and the clinical forms of OLP?
Mild inflammation leads to hyperkeratosis
What is the significance of Wickham's striae in desquamative gingivitis?
Simplifies the diagnosis of lichen planus
What is the characteristic of lesions in OLP that distinguishes them from other lesions?
Lesions are surrounded by a network of bluish white lines called Wickham's striae
What is the characteristic feature of ulcerative lichen planus?
Chronic multiple shallow ulcers with pseudo membrane
What is the duration of lesions in OLP?
8-15 years
What is the difference between the central and peripheral parts of erythematous and ulcerative lesions?
Central part has intense inflammation, periphery has less inflammation
Which of the following is a characteristic of papular OLP?
Pin head size white keratotic papules
What is the significance of the presence of white reticular or papular structures in OLP?
Indicates the presence of mild subepithelial inflammation
What is the difference between plaque pattern in OLP and leukoplakia?
OLP has no loss of pliability and flexibility, while leukoplakia does
Which of the following is a characteristic of atrophic OLP?
It presents as inflamed areas of the oral mucosa covered by thinned red-appearing epithelium
What is the chief complaint of patients with atrophic OLP?
Symptomatic with symptoms that range from mild burning sensation to severe pain
What is the most common form of OLP?
Reticular OLP
What is the characteristic of reticular OLP?
A fine network of bluish white lines called Wickham striae
Study Notes
Bullous OLP
- Characterized by severe degenerative changes in the basal layer of epithelium, leading to the development of vesicles or bullae
- Bullae and vesicles eventually rupture, resulting in chronic, shallow, irregular ulcers covered by a pseudo-membrane and surrounded by an erythematous halo
- Lesions are usually present for weeks to months (chronic oral ulcers) and are often painful, interfering with daily life
Desquamative Gingivitis
- Characterized by bright red, edematous patches that involve the entire width of the attached gingiva
- Not a disease entity, but a sign of disease that can be seen in lichen planus, pemphigus vulgaris, or mucous membrane pemphigoid
- Desquamative gingivitis caused by lichen planus is accompanied by Wickham's striae, simplifying the diagnosis
Clinical Forms of OLP
- Different clinical forms related to the magnitude of subepithelial inflammation
- Mild inflammation may provoke the epithelium to produce hyperkeratosis, appearing as atrophy/ulceration
- Erythematous and ulcerative lesions are often surrounded by white reticular or papular structures
Histopathology of LP
- Three essential features:
- Hyperkeratosis with thickening of the granular cell layer and a saw-toothed appearance of the rete pegs
- "Liquefaction degeneration" or necrosis of the basal cell layer
- A dense subepithelial band of lymphocytes composed mainly of T-cells
- Other features include:
- Civatte bodies (apoptotic cells)
- Increase in Langerhans cells within the epithelium
- Dermal band-like infiltrate of lymphocytes and some macrophages
- Eosinophilic colloid bodies in the papillary dermis
Papular OLP
- Characterized by pinhead-sized white keratotic papules, which may be discrete or arranged in various patterns
- Papules do not disappear on stretching, do not cause loss of pliability and flexibility of the oral mucosa, and are surrounded by Wickham's striae
- Lesions are often asymptomatic, but may cause roughness of the cheek or change in color of the lip
Reticular OLP
- Characterized by a fine network of bluish-white lines (Wickham's striae) radiating from the periphery of the lesion
- Most common form of lichen planus and is often identified during a routine oral examination
- Typically asymptomatic and painless
Atrophic OLP
- Characterized by inflamed areas of the oral mucosa covered by thinned, red-appearing epithelium
- Erosive lesions may develop as a complication of atrophy when the thin epithelium is abraded
- Lesions are often symptomatic, with symptoms ranging from mild burning sensations to severe pain
This quiz covers the characteristics and symptoms of bullous oral lichen planus, including the development of vesicles and bullae, chronic ulcers, and erythematous halo.
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