Clinicopathological Correlation of Oral Lichen Planus

Suchitra, G (2008) Clinicopathological Correlation of Oral Lichen Planus. Masters thesis, Stanley Medical College, Chennai.


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INTRODUCTION : Oral lichen planus is a chronic inflammatory disease of oral mucosa with associated skin involvement. Oral lichen planus is difficult to treat and typically lasts longer than cutaneous lichen planus. It is a disease of remissions and exacerbations and is commonly a disease of the elderly. The oral mucosa forms an interface between the milieu interior and the external environment. The clinical and morphological changes seen in the oral mucosa are due to the interaction of both extrinsic and intrinsic forces. Careful examination of the oral cavity should be an integral part of a detailed physical examination. Lichen planus has a significant association of the skin lesions with those of mucous membrane. The diagnosis of oral lichen planus may pose a challenge because of the difficult visualization of the oral lesions. Other factors that interfere with diagnosis are alteration in the original appearance due to maceration from moisture, abrasion due to sharp tooth, food and infections. Oral lichen planus is often diagnosed in dental clinics during routine check up, because asymptomatic patients may be unaware of the lesions in the mouth. Patients with severe types like erosive lichen planus present earlier to a dermatologist. The pathological significance of the disorders affecting the oral mucosa may be a reflection of internal disease. Oral lichen planus has a premalignant potential. Hence, knowledge about the various precipitating factors and modes of presentation of oral lichen planus may help in predicting the course of the disease. Further, it helps in early treatment and prevention of further complications. AIMS : 1. To study the age and sex incidence of oral lichen planus. 2. To look for any known provocative factors in the onset of oral lichen planus. 3. To study the various types of clinical presentation of oral lichen planus. 4. To study the various sites of distribution of oral lichen planus. 5. To study the associated disorders in oral lichen planus 6. To study the histopathological features of various clinical types of oral lichen planus MATERIALS AND METHODS : The patients for this study were selected from the Outpatient Department of Dematology, Government Stanley Hospital, Chennai. All cases of Lichen Planus were screened for oral mucosal lesions and other patients who presented with oral lesions were examined specially to rule out Lichen Planus. Patients were enrolled and consent obtained for study, biopsy and clinical photo. The cases were given a thorough clinical examination. Detailed enquiries were made with regards to the symptoms and their duration, nature of occupation and history of taking any drugs prior to the development of lesion. Detailed personal history regarding other skin diseases, personal habits, exposure to sexually transmitted diseases and the possibility of emotional or physical stress prior to the onset of the lesions were recorded. Family H/o similar skin lesions, Diabetes Mellitus and Hypertension were asked for. History of remissions and exacerbation with or without treatment was noted. All the cases were given a routine general check up with special reference to skin and nail changes. Hypertension was ruled out by appropriate measures. Patients were examined under good light, magnifying lens and retractor. The sites affected, the types of changes in the mucous membrane, skin and nail changes along with associated skin disorders if any were made note of. Systemic examination was done in all cases to rule out systemic disorder. All patients were referred to ENT and Dental department to rule out focal sepsis. SUMMARY : 1. The number of male patients affected is more than female patients. 2. The peak age incidence in males is thirty one to forty years. 3. The peak age incidence in females is twenty one to thirty years. 4. The youngest age affected is sixteen years and oldest age is seventy years. 5. Emotional stress is the predisposing factor in 30% of patients. 6. The most common morphological type is reticular pattern. 7. Male patients, who were smokers had plaque type of oral lichen planus. 8. Fifteen patients had cutaneous lichen planus and four patients had genital lesions. 9. Two patients had hypertension, three had diabetes mellitus and two patients had vitiligo. 10. Classical histopathological changes are seen in oral as well as cutaneous lesions. CONCLUSION : In this study of oral lichen planus conducted with a sample of thirty patients, a male predominance has been observed. But previous studies report a female predominance or equal sex incidence in oral lichen planus. Male preponderance observed in our study could be attributed to the smaller sample size or could be due to health seeking behaviour of males in our country. More over, the proximity of our institution to the industrial belt, facilitates easy access for males to the skin OPD. Reticular type of oral lichen planus was the commonest type as per literature. Erosive type was the second most common type showing marked basal cell degeneration. Plaque type showed features of classical lichen planus along with marked acanthosis. Papular type showed significant pigmentary incontinence and atrophic type showed significant epidermal thinning along with features of lichen planus. None of the patients showed features of dysplasia. The patients with ulcerative and erosive type of oral lichen planus have to be followed up at 6 monthly intervals and preferably with histo pathological correlation, because it has been reported that malignant transformation is common in these types of oral lichen planus. In our study risk factors like stress and smoking played a significant role in the pathogenesis of oral lichen planus. In future, studies with larger sample size and longer duration have to be undertaken for better analysis of the risk factors involved and for better clinico pathological correlation which will help in early detection of malignancy and management.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Oral Lichen Planus ; Clinicopathological Correlation.
Subjects: MEDICAL > Dermatology Venereology and Leprosy
Depositing User: Subramani R
Date Deposited: 02 Mar 2018 02:14
Last Modified: 02 Mar 2018 02:14

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