12 Mestering the BDs IVeh YearLat 20 Years Solved Questions)

ofliquefaction degeneration of
Sace, Antigenic signals are iransfered from LAngerha18 juxta-epithelial band. of basal cell
clls to the lymphocvtos whenthere is mutual expression
of HLA-DR. Normalv lymphocytes get attracted toward
of civatte bodies
and inf
Immunofluorescent presence oflammatory celllayer ot e
HLA-DR expressing the kotatinovtes And can ontact the study: Direct
Maantixs-era.josepinhfltrale elei
im uno(ifburionroegsTecnheneres
cpithelial cell. At the timen this (ontact, inproer ehen Ia ppositive with IyA, IgM
and IgG
anigenic signal is passd to lymphovtrs lvuse ot HA of aubepithellal shaggy deposit of
PR linkage. As per this mehanism, kelt antigen can e membrane zone,
p
gnizdas onign hoy whih caus% destiution of aN DIMerentlal Dlagnosls at ba
ells protucing autoimmune son0.
Cet hen planus o0rintamilios, twins and husband Leukoplakia: Men are more
ahi wite, But it has alu sugeestd that familial cause can
te nvinnmental and is elatod to infection as compared
Wickham' s striae are not commonly
present,
a
Candidiasis:
Pseudomembrane is
striationrubbed
tv gnetis. Pemplhigus: Clinical white
saHN or Patients having severe psychological in cases. of lichenoff
strss such as adeath of closc friend or relative. Marital or
sCual pnblems, carrier problems, loss of job andsecurity Lupus erythematosus: Fleeky and
and exam problems.
Habits: Lichen planus is associated with tobacco habit.
Tobac and betel chewers have incroased tendency
lupus lesion.
White sponge nevus: It is seen at
planus is seen over age of 30 years.birth
feathandery ap eatm
redness in puheberty. liee
lihen planus. of oral Geographic tongue: Presence of
Misccllaneous:B1,Oral lichen planus also o00ur due to deficiency slightly raised margins which
ofvitamin B6 and C. can
Lichenoid drug reaction: Systemic change their scheanptee. w
Clinical Features
Itoccurs in males from 35 to 44 1vears and in
females from 45
given for 2 weeks, if there is no
reaction is the diagnosis. corimtpricosovement
teroids sholichent
to 54 years. More Management
predilection is toward females.
Common sites are buccal mucosa and to lesser
lips, gingiva, floor of mouth extent tongue, Management of Oral Lichen PlanuS
P'atient may report with burningand palate. There is no known cure for oral lichen
Oral lesion is sensation of oral mucosa. management of symptoms guidesthe t planus. So the
characterized by radiating white and gray
velvety thread-like
arrangement.
papules linear, angular and retiform
in
Wickham's striae: Tiny white elevated dots are
intersection of white lines called present on
Systemic and Oral
corticosteroids
predictable, and successful
and symptomsassociated with medications
Topical medications consisting of
have
sfor therapeutconticaprolrionagte
been the mosg
lichen planus. sis
Six Poflichen planus: P's Wickham's striae. high-poteno
i.e. they are planar, characterize lesions of lichen planus,
corticosteroids, i.e. 0.05%
and triamcinolorne acetonidefluocinonide, 0.05% cloha
plaques. polygonal, purple, pruritic, papules and of
0.1 %. Various oral susnensm
In some of the
cases
triamcinolone,
as betamethasone high-potency steroid mouthwashes sut
present. superimposed candidal infection is valerate 0.1%, fluocinolone acetonide0]y
and clobetasol propionate 0.05% have
Reticular tupe: It is most
shows Wickham's striae. common form and is bilateral. It Extensive-erosive lesions of oral lichen been used efectivek.
planus on gingiva,iz
Papular: White elevated lesions are present desquamative gingivitis may be treated effectively by using
Imm in size and are seen over the which are 0.5 to occlusive splints as carriers for the topical steroid.
mucosa. keratinized areas of oral Topical or systemic antifungal should be given to the patiat
as there is fungal overgrowth
Plaque: These are seen over steroid therapy. present when patient su
mucosa. If plaque is present dorsum
of tongue and the buccal
on tongue, there is Systemic steroids are only indicated for brief treatment u
of papilla. Concentric disappearance
peripheral growth is reported. severe exacerbations or for short periods of treatment
Atrophic form: This is smooth, red, poorly defined area. In recalcitrant cases which fail to respond to the topical stero
this attached gingiva is frequently
of atrophic zones, white keratotic affected. At the margins Under systemic administration of corticosteroids, preansand
radiate peripherally and blend in the striae are evident which tablets may be given with dosages varying between W
surrounding mucosa. 80 mg daily for less than 10 days without tapering.Dosag
Bullous form: It consists of vesicles and bullae which are short regimens are determined individually, based onthe patienl
lived. On ulceration they leave surface. It occurs
mucosa and the posterior as well as lateral margins ofon buccal medical status, severity of disease and previoustreatmet
Malignant transformation of oral lichen planus rangestongue.from
responses.
In patients whom underlying ssystemic j problems areprese
0.4 to 12.3%. In India it is 0.4%. Pphysicianshould
Diagnosis/nvestigations
consultation
be done.
with the patient's primary care

withtopkal
Clinical diagnosis: Presence of interlacing white striae which Retinoids are useful, usually in conjunction planus
can be seen bilaterally. Wickham's striae and
Koebner oral lichen
corticosteroids as adjunctive therapy for-transretinoicadil
phenomenon is perfectly diagnostic. Systemic and topically àdministered Ball- topia
Laboratory diagnosis: Incisional biopsy of lesional area vitamin Aacid, systemic etretinate, and systemiCand
applicationof
is done. When it is seen under microscope, it shows isotretinoin are all and topical
retinoid cream or gel Ieffective,
plaque
and
hyperorthokeratosis or hyperparakeratosis, acanthosis of will eliminate reticular
withdrawalofthe
spinal celllayer, saw tooth appearance of rete pegs, presence lesions in many patients. But following
medication, the maiority of lesions recur.