Chronic, life-long incurable disease

T-cell mediated autoimmune disease

Characterized by exacerbation and remission

Treatment is empirical, usually immunomodulating

Regular dental exams and excellent OH are critical

Will always require followup

20-30% skin only

12-50% skin and oral

30-50% oral only *More erosions and symptoms than those w/ only skin or both skin and oral

Less common - genital mucosa; vulvovaginal gingival syndrome 19%

Establish diagnosis:

- Clinical exam only - reticular, bilateral, asympatomatic

- Biopsy unilateral, painful, erosive

- Biopsy multiple/high risk sites for H&E

- Biopsy "gingival lesions only cases" - H&E, DIF

Reticular (90%), plaque, papular, atrophic (5-44%), erosive (9-46%), bullous

- May have more than one type of lesion at any one time

- May dev diff lesions over time

Elimination of irritants/xerostomia

Modification of reversible lichenoid reactions (drugs, dental restorations)

Therapy (topical, systemic)

Topical therapy for biopsy confirmed painful or ulcerative disease

Corticosteroids, retinoids, tacrolimus, azathioprine, cyclosporine

- Directed towards painful, erythematous lesions

- Asymptomatic, reticular lesions should be left untreated unless gingival lesions complicate periodontal health

- No single, universally effective agent

- Multiple agents often necessary

- Treatment is palliative and non-curative

- Improvement is always temporary

- Requires long-term therapy w/ monitoring for adverse effects

- 1-2% incidence of oral SSCA

- Often involves tongue

- Regular followup and repeat biopsies of persistent firm, indurated, exophytic lesions

- Eliminate use of tobacco and alcohol

Consider removal of dental restoration(s) if lesions:

- Develop following placement

- Are located adj to restorations

- Non-curable, chronic disease

- Asympatomatic lichen planus requires diagnosis and life-long followup due to risk of malignancies

- If symptomatic, accurate diagnosis will direct treatment (ex. erosive type, superimposed candidiasis, SCCA)

- A variety of treatments, usually immunomodulating, may be required over a lifetime

- Regular dental treatment w/ excellent oral hygiene is critical, especially w/ gingival lesions or in patients with dry mouth

Nikolsky's sign: minor trauma induces blister

Asboe-Hansen sign: blister will spread by pressing on it

- Blisters are superficial

- Oral ulcers are almost always very painful

- Interfere w/ eating and OH

- Excessive salivation, may be blood tinged

- Oral malodor (halitosis)

- Biopsy site slow to heal

- Oral ulcers heal without scarring

- Uncommon

- Underlying lymphoma, thymoma, leukemia, Castleman's disease, etc.

- Clinically oral lesions resemble erythema multiforme or lupus erythematosus

- Oral lesions severe, large and painful, and often involve vermillion and perioral skin

- DIF: IgG to sqamous epi and all other desmosome-containing epi

Depends on control of underlying disease; due to benign tumor that can be surgically excised, good prognosis

Most have malignant neoplasms and die of disease or complications of treatment

Thickened skin, mask-like facial features

Difficulty swallowing

Shortness of breath

Hand changes

Cold sensitivity in fingers Raynaud's phenomenon

Bone or joint pain

Generalized widening of PDL

Dry mouth, stenosis

- Alleviate symptoms and minimize complications using corticosteroids and antimetabolites

- Hormone relaxin may reduce collagen overproduction

- Gleevac

- Dilate blood vessels, prevent blood clots

- Manage dry mouth

5 year survival rate 80-85%

Lung, heart, and kidney damage cause disability and death