Podcast
Questions and Answers
Which of the following symptoms is NOT typically associated with oral lichen planus?
Which of the following symptoms is NOT typically associated with oral lichen planus?
What is the most frequent extra-oral site involved in oral lichen planus?
What is the most frequent extra-oral site involved in oral lichen planus?
Which clinical type of oral lichen planus is characterized by fine white lines and asymptomatic presentation?
Which clinical type of oral lichen planus is characterized by fine white lines and asymptomatic presentation?
In which condition is the Koebner phenomenon most likely to be observed?
In which condition is the Koebner phenomenon most likely to be observed?
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Which type of lupus erythematosus is characterized by skin lesions and may also present with oral manifestations?
Which type of lupus erythematosus is characterized by skin lesions and may also present with oral manifestations?
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What is a characteristic feature of the papular form of oral lichen planus?
What is a characteristic feature of the papular form of oral lichen planus?
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What process is primarily involved in the pathogenesis of oral lichen planus?
What process is primarily involved in the pathogenesis of oral lichen planus?
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What is a common clinical finding in patients with lupus erythematosus affecting the oral cavity?
What is a common clinical finding in patients with lupus erythematosus affecting the oral cavity?
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What characterizes the plaque-type Oral Lichen Planus (OLP)?
What characterizes the plaque-type Oral Lichen Planus (OLP)?
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Which type of Oral Lichen Planus is most likely to result in malignant transformation?
Which type of Oral Lichen Planus is most likely to result in malignant transformation?
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Which feature is typically seen in the histopathology of OLP?
Which feature is typically seen in the histopathology of OLP?
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What is a common differential diagnosis for erythematous OLP?
What is a common differential diagnosis for erythematous OLP?
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What is the management strategy for Oral Lichen Planus?
What is the management strategy for Oral Lichen Planus?
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What is the typical clinical presentation of Oral Hairy Leukoplakia (OHL)?
What is the typical clinical presentation of Oral Hairy Leukoplakia (OHL)?
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Which of the following is a key feature of discoid lupus erythematosus (DLE) that distinguishes it from OLP?
Which of the following is a key feature of discoid lupus erythematosus (DLE) that distinguishes it from OLP?
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Which type of OLP is often asymptomatic?
Which type of OLP is often asymptomatic?
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In the treatment of oropharyngeal candidiasis, which of the following is contraindicated in patients with liver or renal issues?
In the treatment of oropharyngeal candidiasis, which of the following is contraindicated in patients with liver or renal issues?
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What histopathological finding in OLP is referred to as 'Civatte bodies'?
What histopathological finding in OLP is referred to as 'Civatte bodies'?
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Which virus is strongly associated with Oral Hairy Leukoplakia?
Which virus is strongly associated with Oral Hairy Leukoplakia?
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What characterizes homogenous leukoplakia?
What characterizes homogenous leukoplakia?
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What is a feature that distinguishes oral leukoplakia in terms of cancer risk?
What is a feature that distinguishes oral leukoplakia in terms of cancer risk?
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Which statement about Oral Hairy Leukoplakia (OHL) is true?
Which statement about Oral Hairy Leukoplakia (OHL) is true?
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What is a common misconception regarding Oral Hairy Leukoplakia?
What is a common misconception regarding Oral Hairy Leukoplakia?
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Which of the following correctly describes the histological features associated with premalignant lesions like oral leukoplakia?
Which of the following correctly describes the histological features associated with premalignant lesions like oral leukoplakia?
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Study Notes
Oral Complications
- Oral complications are most commonly observed on the lips, buccal mucosa, retromolar area, and soft palatal mucosa
- Burning sensation, especially with spicy food
- Decreased ability to open the mouth, loss of resiliency affecting speech, tongue mobility
Oral Lichen Planus
- Relates to a dermatosis occurring on the skin and oral mucous membrane
- 50% of patients present with both oral and skin lesions
- Etiology is multifactorial and involves cell-mediated immunologically-induced degeneration of the basal cell layer of the epithelium
- Occurs due to stress
Skin Lesions
- Flat-topped, pruritic erythematous to violaceus papules with fine scaling on the surface
- Predominantly found on the trunk and flexor surfaces of arms and legs
- Most frequent extra-oral mucosa site involved is the genital mucosa
- Lesions are aggravatable by trauma, leading to new skin lesions (Koebner phenomenon)
Clinical Types
- Reticular, Papular, Plaque-like, Bullous, Erythematous, Ulcerative
- For clinical diagnosis of OLP, reticular or papular textures should be present
- OLP confined to the gingiva can be fully erythematous, without reticular or papular elements, requiring biopsy confirmation
Reticular Form
- Characterized by fine white lines or striae (Wickham striae)
- Striae can form a network or annular patterns and often display a peripheral erythematous zone, indicating subepithelial inflammation
- Most frequent site is bilaterally in the buccal mucosa
- Usually asymptomatic
Papular Form
- Common in the initial stages of the disease
- Clinically characterized by small white dots often co-existing with the reticular form
- Asymptomatic
- Differential Diagnosis: Plaque-type OLP, which presents as a homogeneous well-demarcated white plaque with striae
Plaque-like OLP
- Homogeneous well-demarcated white plaque alongside striae
- Clinically similar to homogeneous oral leukoplakias
- Frequent in smokers, with potential for transformation into reticular type following smoking cessation
- Overrepresented among OLP lesions transforming into oral SCC
- Asymptomatic
Erythematous (Atrophic)
- Characterized by a homogeneous red area
- In cases of buccal mucosa or palate involvement, striae are often visible at the lesion periphery
- Can exclusively affect attached gingiva, known as "Desquamative Gingivitis"
Ulcerative Type
- Most disabling form of OLP
- Clinically presents as fibrin-coated ulcers surrounded by an erythematous zone with white striae in the periphery
- Suspected to be associated with malignant transformation
Differential Diagnosis of OLP
- Other lichenoid reactions: Similar clinical and histological presentation, differentiation requires history and cause removal to confirm lesion disappearance
- Discoid Lupus Erythematosus (DLE): Shows white radiating striae resembling OLP but they are more prominent, with hyperkeratinization, and abruptly terminate with sharp demarcation
- LE diagnosis is confirmed by Direct immunofluorescence for immunoglobulin IgM on biopsies of the clinically normal oral mucosa (Lupus Band Test)
- Plaque-like OLP: Differentiated from homogeneous oral leukoplakia
- Erythematous OLP of the gingiva: Similar clinical presentation as mucous membrane pemphigoid
Diagnosis
- Reticular/popular forms are pathognomonic
- Biopsy is mandatory for erythematous OLP
Histopathologic Features
- Subepithelial band-formed infiltrate dominated by T lymphocytes and macrophages
- Degeneration of basal cells (liquefaction degeneration) resulting in Civatte bodies
- Hyperparakeratosis, thickening of granular cell layer
- Saw-toothed appearance of the rete pegs
Management
- Unknown etiology, treatment focuses on symptom management
- Phase 1 therapy: Use of topical corticosteroids (e.g. clobetasol propionate) or tacrolimus ointment
- If phase 1 therapy is insufficient, continuous treatment with topical antifungal drugs (e.g., nystatin) should be considered
- Chlorhexidine can be used, but it can discolor dentures and counteracts the effect of nystatin
Antifungal (Systemic)
- In cases of inaccessible areas (oropharyngeal candidiasis), systemic antifungals are used
- Contraindicated in liver and renal patients, referral is necessary
- Dosage: 200mg on the first day, then 100mg daily for 1-2 weeks
Oral Hairy Leukoplakia (OHL)
- Common HIV-associated oral mucosal lesion
- Used as a marker of disease activity due to association with low CD4+ T lymphocyte counts
- Not pathognomonic for HIV, as it can occur in other states of immune deficiency
- Strongly associated with Epstein Barr virus (EBV) and low levels of CD4+ T lymphocytes
- Antiviral medication, which inhibits EBV replication, is curative
Clinical Presentation
- Most frequent site: lateral borders of the tongue as vertical white folds
- Lesions may also appear as white, somewhat elevated plaque that cannot be scraped off
- Usually asymptomatic, unless superinfected with candidal strains
Diagnosis and Management
- Diagnosis typically based on clinical characteristics
- Histopathologic examination and EBV detection can confirm diagnosis
- Treatment involves antiviral medication
- Spontaneous regression has been reported
- Not associated with increased risk of malignant transformation
Premalignant Lesions
- Development of oral leukoplakia and erythroplakia involves different genetic events
- Activation of oncogenes, deletion and injuries to suppressor genes, and genes responsible for DNA repair contribute to defective genome function that controls cell division
- Malignant transformation may occur following a series of mutations
Oral Leukoplakia
- Homogenous Leukoplakia: White plaque of questionable risk, excluding other known diseases or disorders that carry no increased risk for cancer
- Clinically presents as a white, often well-demarcated plaque with an identical reaction pattern throughout the entire lesion
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Description
This quiz explores the clinical features and complications associated with Oral Lichen Planus. It covers symptoms, skin lesions, and types of this dermatosis, including the unique aspects of oral manifestations and their treatment implications. Assess your understanding of this condition and its effects on oral and skin health.
