Bullous Oral Lichen Planus

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Questions and Answers

What is the characteristic appearance of the rete pegs in Lichen Planus?

Wedge-shaped hypergranulosis

Eosinophilic colloid bodies

Finger-like projections

Saw-toothed appearance (correct)

What is the term for the necrosis of the basal cell layer in Lichen Planus?

Hyperkeratosis

Apoptosis

Liquefaction degeneration (correct)

Cytotoxic effect

What is the primary function of Langerhans cells in the epithelium?

Antigen presentation (correct)

Cell death

Inflammation

Cytotoxic effect

What is the characteristic histopathological feature of classical Lichen Planus?

Dermal band-like infiltrate of lymphocytes and macrophages Signup and view all the answers

What is the term for the small clefts seen at the dermal-epidermal junction?

Caspary-Joseph spaces Signup and view all the answers

What is the term for the shrunken cells with pyknotic nuclear fragments seen in the epithelium?

Civatte bodies Signup and view all the answers

In Papular Lichen Planus, what is the characteristic feature of the stratum corneum?

Increase in width Signup and view all the answers

What is the mechanism of cell death of basal cells by T-lymphocytes?

Both cytotoxic effect and apoptosis Signup and view all the answers

What is the main characteristic of bullous OLP?

Development of vesicles or bullae Signup and view all the answers

What is the chief complaint of patients with ulcerative lichen planus?

Pain that interferes with function and quality of life Signup and view all the answers

What is the characteristic feature of desquamative gingivitis in lichen planus?

Bright red edematous patches with marked edema Signup and view all the answers

What is the relationship between the magnitude of subepithelial inflammation and the clinical forms of OLP?

Mild inflammation leads to hyperkeratosis Signup and view all the answers

What is the significance of Wickham's striae in desquamative gingivitis?

Simplifies the diagnosis of lichen planus Signup and view all the answers

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 Signup and view all the answers

What is the characteristic feature of ulcerative lichen planus?

Chronic multiple shallow ulcers with pseudo membrane Signup and view all the answers

What is the duration of lesions in OLP?

8-15 years Signup and view all the answers

What is the difference between the central and peripheral parts of erythematous and ulcerative lesions?

Central part has intense inflammation, periphery has less inflammation Signup and view all the answers

Which of the following is a characteristic of papular OLP?

Pin head size white keratotic papules Signup and view all the answers

What is the significance of the presence of white reticular or papular structures in OLP?

Indicates the presence of mild subepithelial inflammation Signup and view all the answers

What is the difference between plaque pattern in OLP and leukoplakia?

OLP has no loss of pliability and flexibility, while leukoplakia does Signup and view all the answers

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 Signup and view all the answers

What is the chief complaint of patients with atrophic OLP?

Symptomatic with symptoms that range from mild burning sensation to severe pain Signup and view all the answers

What is the most common form of OLP?

Reticular OLP Signup and view all the answers

What is the characteristic of reticular OLP?

A fine network of bluish white lines called Wickham striae Signup and view all the answers

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

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Description

This quiz covers the characteristics and symptoms of bullous oral lichen planus, including the development of vesicles and bullae, chronic ulcers, and erythematous halo.