Lichen planus - Knowledge (XXG)

462: 536: 302:'Ring-shaped' lesions that develop gradually from single small pigmented spots into circular groups of papules with clear, unaffected skin in the center. The ring-like lesions may very slowly enlarge, co-join and morph into larger irregular (serpentine) bands, sometimes accompanied by lines (See Linear, below). Annular CLP is uncommon and classically involves the male genitalia (glans penis and penile shaft), groin, axilla and also the extremities. 1159: 51: 454: 1088: 1366:

markings by correlating with an increase thickness of the granular cell layer. The coexistence of oral, cervical and stomach lichen planus lesions were described by Guogerot and Burnier in 1937. A similar variant of mucosal lichen planus as the vulvovaginal-gingival syndrome with erosive lesions involving oral and vulvovaginal mucosa were introduced by Pelisse and colleagues in year 1982.

621: 4722: 437: 172:), commonly affecting dorsal hands, flexural wrists and forearms, trunk, anterior lower legs and oral mucosa. The hue may be gray-brown in people with darker skin. Although there is a broad clinical range of LP manifestations, the skin and oral cavity remain as the major sites of involvement. The cause is unknown, but it is thought to be the result of an 514:(also known as "Nekam's disease") is a rare dermatosis characterized by violaceous papular and nodular lesions, often arranged in a linear or reticulate pattern on the dorsal hands and feet, extremities, and buttock, and some cases manifest by seborrheic dermatitis-like eruption on the scalp and face; also palmo plantar keratosis has been reported. 732:

include a burning sensation to severe pain. They may also experience mucosal bleeding in response to mild trauma, such as toothbrushing. Additionally, the Koebner phenomenon (the development of new lesions at sites of trauma) is not only present in cutaneous lichen planus (CLP) but can also occur in the setting of OLP.

520:(also known as "benign lichenoid keratosis", and "Solitary lichen planus") is a cutaneous condition characterized by brown to red scaling maculopapules, found on sun-exposed skin of extremities. Restated, this is a cutaneous condition usually characterized by a solitary dusky-red to violaceous papular skin lesion. 1365:

as an inflammatory disorder with unknown etiology. Initially, the characteristic surface markings or striae was described by Weyl in 1885. In 1895, Wickham further explained the characteristic of the lesion, now known as Wickham striae. Further on, Darier explained the presence of such characteristic

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Lacy, reticulated plaques or erosions that resemble oral LP may occur in GVHD. The histologic findings of these disorders are also similar. The patient history is useful for differentiating chronic GVHD from oral LP. Oral involvement in acute GVHD is less well characterized than chronic GVHD, but has

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Stress is thought to play a role in the pathogenesis of oral LP. Patients with anxiety and depression are reported more commonly with oral LP if compared to normal healthy individuals. Some studies have indicated that stressful events can induce LP lesions in otherwise healthy individuals. However, a

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Tissue biopsies of oral LP help to confirm the diagnosis and are particularly of value for erythematous and erosive LP, which share features with multiple other mucosal disorders, including oral malignancy. Biopsies to confirm oral LP are less essential in patients who present with classic reticular

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Generally, oral lichen planus tends not to cause any discomfort or pain, although some people may experience soreness when eating or drinking acidic or spicy foodstuffs or beverages. When symptoms arise, they are most commonly associated with the atrophic and ulcerative subtypes. These symptoms can

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Hair and scalp. The scalp is rarely affected by a condition known as lichen planopilaris, acuminatus, follicular lichen planus, and peripilaris, characterised by violaceous, adherent follicular scale with progressive scarring alopecia. While lichen planus and lichen planopilaris may occur together,

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Characterized by extensive erythematous lesions with poorly defined borders and in part with lichenification. Inverse LP typically affects the axillae, inguinal creases, limb flexures and submammary region. Pigmentation of the individual lesions at these inverse locations are typical. Additionally,

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A full examination that includes the evaluation of the mucosal and cutaneous surfaces, including the vulva, vagina, penis, scalp, and nails should be performed. Thorough examination may lead to the detection of extraoral manifestations of LP that provide additional support for the diagnosis or the

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Although lichen planus can present with a variety of lesions, the most common presentation is as a well defined area of purple-coloured, itchy, flat-topped papules with interspersed lacy white lines (Wickham's striae). This description is known as the characteristic "6 Ps" of lichen planus: planar

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aside from sharing the term 'lichen' and revealing inflammation on skin biopsy, there is neither established data on their co-occurrence nor data to suggest a common etiology. Lichen planopilaris is considered an orphan disease with no definitive prevalence data and no proven effective treatments.

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Patient history and clinical presentation need to be taken to diagnose lichen planus. Patients with suspected cutaneous lichen planus need to be evaluated clinically through patient interviews and physical examinations. Patients should be questioned about their medication history, any history of

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Papular form is the classic cutaneous lichen planus (CLP) lesion characterized by shiny, red or purple-colored, flat-topped papule. Lesions may have a thin, transparent, and adherent scale. Fine whitish points or lacy lines (Wickham's striae) may be seen on the surface of well-developed papules.

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This pattern is characterized by hyperkeratotic thick pruritic red-brown to purple-gray plaques with follicular accentuation. Hypertrophic CLP commonly involves the extremities, especially the interphalangeal joints and the anterior legs in a symmetrical distribution. This form is also known as

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Many different treatments have been reported for cutaneous lichen planus, however there is a general lack of evidence of efficacy for any treatment. Treatments tend to be prolonged, partially effective and disappointing. The mainstay of localized skin lesions is topical steroids. Additional

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Rare form of OLP characterized by fluid-filled vesicles ranging in size from 1 to 2 mm to several cm in diameter. The vesicles or bullae appear white or gray-purple in color and are fluctuant. The fluid in the vesicles are usually clear but may be hemorrhagic or purulent upon secondary

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Oral lichenoid contact reactions may be caused by a variety of substances. The clinical and histologic features of oral lichenoid contact reactions are similar to oral LP. Patch testing and recognition of the proximity of an offending substance to the eruption can aid with diagnosis.

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Oral LP may also be caused by genetic factor which influence the immune function. A separate study performed in China found an association between a polymorphism in the TNF-alpha gene and risk for oral LP in a subset of patients. An Italian study found a significant increase in a

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Majdy Idrees, Camile S Farah, Syed Ali Khurram, Norman Firth, Merva Soluk-Tekkesin, Omar Kujan. 2021, Observer agreement in the diagnosis of oral lichen planus using the proposed criteria of the American Academy of Oral and Maxillofacial Pathology. J Oral Pathol Med 2021 Mar 17.

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Cutaneous lichen planus affecting the extremities is also known as "lichen planus actinicus", "Actinic lichen niditus", "Lichen planus atrophicus annularis", "Lichen planus subtropicus", "Lichen planus tropicus", "Lichenoid melanodermatitis", and "Summertime actinic lichenoid

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remains a possibility. A single study of cutaneous LP reported evidence in support of autoimmunity by expanding in vitro T cells isolated from the skin lesions of two patients, followed by testing the ability of these T cells to kill autologous keratinocytes (cytotoxicity).

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This form is a common presentation that has similarities to the erosive form. It has a more prominent atrophic lesion on a background of erythema with radiating white striae at the margins. Atrophic oral lichen planus may also manifest as desquamative gingivitis.

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or plaques with central superficial atrophy. Atrophic CLP is the clinical endpoint of chronic annular or hypertrophic LP with atrophic lesions. The use of potent topical corticosteroids for a long-term may predispose the patient to developing atrophic lesions.

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Lallas, A.; Kyrgidis, A.; Tzellos, T. G.; Apalla, Z.; Karakyriou, E.; Karatolias, A.; Lefaki, I.; Sotiriou, E.; Ioannides, D. (June 2012). "Accuracy of dermoscopic criteria for the diagnosis of psoriasis, dermatitis, lichen planus and pityriasis rosea".

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Oral LP is considered to be a T-cell mediated chronic inflammatory tissue reaction that results in a cytotoxic reaction against epithelial basal cells. The inflammatory infiltrate in oral LP is primarily composed of CD8+ T cells. A potential pathway for

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Cutaneous LP is a self-limiting condition. It usually resolves within 6 to 12 months. Oral LP is a non infectious, chronic inflammatory condition that involves the oral mucosa and may be accompanied by skin lesions. The etiology of oral LP are unknown.

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Although this condition was first described almost a century ago, it has been reported that its associated oral cancer risk has been exaggerated. Overall, it is found that patients with erythematous or erosive oral lichen planus have a higher risk of

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Rare form presenting as nummular patches or plaques with a hypopigmented halo surrounding a hyperpigmented center. Actinic CLP is more prevalent in African Americans, Indians, and Middle-Eastern individuals and commonly affects the sun-exposed areas.

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Lichen planus can occur in patients as diverse cutaneous manifestations alone or in combination with mucosal lichen planus and, or lichen planus of the nails. Study shows that frequency of mucosal involvement of lichen planus patients is 30- 70%.

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There is no cure for lichen planus, and so treatment of cutaneous and oral lichen planus is for symptomatic relief or due to cosmetic concerns. When medical treatment is pursued, first-line treatment typically involves either topical or systemic

389:, seen in a familial pattern and also predominantly in women, is characterized by the appearance of follicular LP on the trunk with LP follicularis decalvans on the scalp. Follicular LP on the scalp is more likely to lead to scarring alopecia. 4765: 4750: 1349:

in the general population is about 1.27–2.0%, and it occurs more commonly in middle aged people. Oral lichen planus in children is rare. About 50% of females with oral lichen planus were reported to have undiagnosed vulvar lichen planus.

4879: 894:. Examination of entire cutaneous surface including the scalp, oral cavity and external genitalia need to be included. Wickham's striae often can be seen during microscopic examination of cutaneous lesions of lichen planus. 445:(flat-topped), purple, polygonal, pruritic, papules, and plaques. This rash, after regressing, is likely to leave an area of hyperpigmentation that slowly fades. That said, a variety of other lesions can also occur. 4481:

Carbone M, Arduino PG, Carrozzo M, Gandolfo S, Argiolas MR, Bertolusso G, Conrotto D, Pentenero M, Broccoletti R (April 2009). "Course of oral lichen planus: a retrospective study of 808 northern Italian patients".

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Ebrahimi M, Lundqvist L, Wahlin YB, Nylander E (October 2012). "Mucosal lichen planus, a systemic disease requiring multidisciplinary care: a cross-sectional clinical review from a multidisciplinary perspective".

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overlap syndrome. Lesions of this syndrome share features of both lupus erythematosus and lichen planus. Lesions are usually large and hypopigmented, atrophic, and with a red to blue colour and minimal scaling.

1286:) are sometimes used. While topical steroids are widely accepted as first line treatment for mucosal lichen planus, there is only weak evidence to support their effectiveness for erosive oral lichen planus. 834:(TNF)-alpha, secretion of granzyme B, or Fas-Fas ligand interactions. Chemokines are produced by activated CD8+ T cells that attract additional inflammatory cells, thereby promoting continued inflammation. 735:

Residual postinflammatory hyperpigmentation has been reported in association with OLP, manifesting as brown to black pigmentation on the oral mucosa and may most likely occur in dark-skinned individuals.

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van der Meij EH, Mast H, van der Waal I (September 2007). "The possible premalignant character of oral lichen planus and oral lichenoid lesions: a prospective five-year follow-up study of 192 patients".

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This form is characterized by small white pinpoint papules that are asymptomatic. Hence, they can be easily missed during a routine checkup. It is referred to as the initial and transient phase of OLP.

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Antiga E, Caproni M, Parodi A, Cianchini G, Fabbri P (December 2014). "Treatment of cutaneous lichen planus: an evidence based analysis of efficacy by the Italian Group for Cutaneous Immunopathology".

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History of dental restorations, use of dental appliances, or oral exposure to substances that may cause oral lichenoid contact eruptions (e.g. dental composites, cobalt chromium based dentures etc.)

1113:(SCC) can present as erythematous or white patches, ulcers, or exophytic masses. The highest risk for oral SCC may occur in patients with erythematous or erosive oral LP. A biopsy is indicated. 739:

OLP may occur as a sole manifestation of the disease or in conjunction with other clinical manifestations of LP, including cutaneous LP, genital LP, nail LP, and lichen planopilaris (scalp LP).

728:, although any mucosal site in the mouth may be involved. Other sites, in decreasing order of frequency, may include the tongue, lips, gingivae, floor of the mouth, and very rarely, the palate. 679:, ulcerations and erosions covered with a yellow slough. This can occur in one or more areas of the mouth. In 25% of people with erosive oral lichen planus, the gums are involved, described as 1294:

Cutaneous lichen planus lesions typically resolve within six months to a year. However, some variant such as the hypertrophic variant might persist for years if left untreated or unmonitored.

4706: 4865: 683:(a condition not unique to lichen planus). This may be the initial or only sign of the condition. Involvement of the dorsum of the tongue might cause an altered sense of taste (dysgeusia). 344:

This morphology is characterized by the development of vesicles and bullae with the skin lesions. This is a rare variant of lichen planus, and also known as "vesiculobullous lichen planus".

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The histologic findings of oral LP can offer strong support for the diagnosis, but are not pathognomonic. Clinical correlation is required. Common histologic findings of oral LP include:

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Paul J, Foss CE, Hirano SA, Cunningham TD, Pariser DM (February 2013). "An open-label pilot study of apremilast for the treatment of moderate to severe lichen planus: a case series".

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Janardhanam SB, Prakasam S, Swaminathan VT, Kodumudi KN, Zunt SL, Srinivasan M (May 2012). "Differential expression of TLR-2 and TLR-4 in the epithelial cells in oral lichen planus".

6286: 603:, and gums, with complications including scarring, vaginal stricture formation, or vulva destruction. The corresponding syndrome in males, affecting the glans penis and gums, is the 473:

Extremities (face, dorsal hands, arms, and nape of neck). This is more common in Middle Eastern countries in spring and summer, where sunlight appears to have a precipitating effect.

1301:. In contrast to cutaneous LP, which is self limited, lichen planus lesions in the mouth may persist for many years, and tend to be difficult to treat, with relapses being common. 1102:

that may be a precursor to oral squamous cell carcinoma. White patches or plaques usually appear on the oral mucosa. To rule out malignancy, a biopsy of leukoplakia is indicated.

7567: 1140:(also known as thrush) is a common infection that has a predilection for infants, older adults with dentures, immunosuppressed individuals, and individuals utilizing intraoral 6281: 6002: 3721:

Hietanen J, Paasonen MR, Kuhlefelt M, Malmström M (May 1999). "A retrospective study of oral lichen planus patients with concurrent or subsequent development of malignancy".

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Nagao T, Ikeda N, Fukano H, Hashimoto S, Shimozato K, Warnakulasuriya S (October 2005). "Incidence rates for oral leukoplakia and lichen planus in a Japanese population".

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similar to that seen in erosive LP. Biopsies for routine histologic examination and direct immunofluorescence are useful for distinguishing these disorders from oral LP.

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Lichenoid drug eruptions may be caused by a variety of systemic medications and share clinical features with oral LP. Histologic findings of a deep mixed infiltrate with

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The origin of the word is believed to be from the Greek word ''Leichen'', which means tree moss, and also from Latin word ''planus'', which means flat and even surface.

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Patients with oral lichen planus should be followed-up at least every 6 to 12 months, to assess the disease activity, changes in symptoms or even detect early signs of

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formation, shedding of the nail plate with atrophy of the nail bed, subungual keratosis, longitudinal erthronychia (red streaks), and subungual hyperpigmentation. A

6371: 1206:, and removal of any triggers. Without treatment, most lesions will spontaneously resolve within 6–9 months for cutaneous lesions, and longer for mucosal lesions. 8416: 6796: 4622:

Thorn JJ, Holmstrup P, Rindum J, Pindborg JJ (May 1988). "Course of various clinical forms of oral lichen planus. A prospective follow-up study of 611 patients".

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Nonetheless, interpreting the histopathological features of oral LP has been associated historically with high intra-observer and inter-observer variabilities.

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therapy. Patients present with white plaques or erythematous patches on the buccal mucosa, palate, tongue, or oropharynx that may be mistaken for reticular LP.

168:, but is named for its appearance. It is characterized by polygonal, flat-topped, violaceous papules and plaques with overlying, reticulated, fine white scale ( 751:

It is not clear whether the mechanisms causing isolated oral LP are different from those causing oral LP with cutaneous LP. An immune-mediated mechanism where

640:, the lining of the mouth. This may occur in combination with other variants of lichen planus. Six clinical forms of oral lichen planus (OLP) are recognized: 176:

process with an unknown initial trigger. There is no cure, but many different medications and procedures have been used in efforts to control the symptoms.

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Issa Y, Brunton PA, Glenny AM, Duxbury AJ (November 2004). "Healing of oral lichenoid lesions after replacing amalgam restorations: a systematic review".

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It generally occurs more commonly in females, in a ratio of 3:2, and most cases are diagnosed between the ages of 30 and 60, but it can occur at any age.

4172:"Oral lichen planus has a very low malignant transformation rate: A systematic review and meta-analysis using strict diagnostic and inclusion criteria" 659:

The most common presentation of oral lichen planus (OLP) is characterised by the net-like or spider web-like appearance of lacy white lines, known as

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Characterized by follicular, flat, elevated or hemispherical erythematous papules with or without keratoses presenting in groups or disseminated. The

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Some studies suggest that cutaneous lichen planus is more commonly found in men whilst oral lichen planus lesions are more commonly found in women.

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Roopashree MR, Gondhalekar RV, Shashikanth MC, George J, Thippeswamy SH, Shukla A (November 2010). "Pathogenesis of oral lichen planus--a review".

1316:, patients with oral lichen planus are encouraged to avoid activities known to increase the risk for oral cancer, such as smoking and alcohol use. 8381: 7579: 7530: 1153: 469:

Variants of cutaneous lichen planus are distinguished based upon the appearance of the lesions and/or their distribution. Lesions can affect the:

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Miller CS, Epstein JB, Hall EH, Sirois D (January 2001). "Changing oral care needs in the United States: the continuing need for oral medicine".

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Eisen D (February 2002). "The clinical features, malignant potential, and systemic associations of oral lichen planus: a study of 723 patients".

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LP, particularly in patients in whom a diagnosis of LP has already been confirmed through biopsy of an extraoral manifestation of this disorder.

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Large, homogenous white patches are characteristic of this form which may resemble leukoplakia. This form is more prevalent in tobacco smokers.

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Bouquot JE, Gorlin RJ (April 1986). "Leukoplakia, lichen planus, and other oral keratoses in 23,616 white Americans over the age of 35 years".

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Farhi D, Dupin N (2010). "Pathophysiology, etiologic factors, and clinical management of oral lichen planus, part I: facts and controversies".

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History of LP involving other body sites or other skin disorders that may present with similar findings (e.g., autoimmune blistering diseases)

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Lichen planus affecting mucosal surfaces may have one lesion or be multifocal. Examples of lichen planus affecting mucosal surfaces include:

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Carrozzo M, Uboldi de Capei M, Dametto E, Fasano ME, Arduino P, Broccoletti R, Vezza D, Rendine S, Curtoni ES, Gandolfo S (January 2004).

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A diagnosis of oral lichen planus (LP) is confirmed through review of the patient history, physical examination, and histologic findings.

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characterized by the development of tense blisters atop lesions of lichen planus or the development vesicles de novo on uninvolved skin.

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These types often coexist in the same individual. Oral lichen planus (OLP) tends to present bilaterally as mostly white lesions on the

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Xue JL, Fan MW, Wang SZ, Chen XM, Li Y, Wang L (September 2005). "A clinical study of 674 patients with oral lichen planus in China".

663:. This is usually asymptomatic. Reticular OLP may progress to the more severe subtypes, such as the erosive form, if left untreated. 8308: 6941: 5946: 5362: 3516: 2954: 1733: 1708: 1681: 831: 820:

activates CD8+ T cells on keratinocytes or by encounters with activated CD4+ helper T cells or cytokines produced by activated CD4+

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Gorouhi, F; Firooz A; Khatami A; Ladoyanni E; Bouzari N; Kamangar F; Gill JK (2009). "Interventions for cutaneous lichen planus".

763:) and cytokines associated with T-helper 1 immune response, may also play an important role in the pathogenesis of lichen planus. 8283: 8220: 8215: 8097: 7525: 7505: 6417: 6012: 5471: 4100: 4037:

Cribier B, Frances C, Chosidow O (December 1998). "Treatment of lichen planus. An evidence-based medicine analysis of efficacy".

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are considered initial management for symptomatic OLP, and these measures are reported to be useful. Treatment usually involves

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is a common, benign finding in the oral cavity that presents as white-gray, somewhat translucent plaques on the mucosa. The

203:). Sometimes dental materials or certain medications can cause lichenoid reactions. They can also occur in association with 3868: 7954: 5623: 5314: 5151: 1497:"Cutaneous and mucosal lichen planus: a comprehensive review of clinical subtypes, risk factors, diagnosis, and prognosis" 6336: 5166: 8421: 8406: 7478: 7087: 6791: 6776: 6714: 6660: 6583: 6401: 6122: 6027: 5790: 5545: 5236: 1110: 8006: 7969: 7699: 6980: 6892: 5540: 5071: 5026: 1018: 910: 576: 8016: 7964: 7771: 7704: 7473: 6973: 6968: 6919: 6303: 6259: 6217: 6128: 6114: 6022: 5893: 5613: 3348:"Tumor necrosis factor-alpha and interferon-gamma polymorphisms contribute to susceptibility to oral lichen planus" 1063: 4711: 485:

Nails characterized by irregular longitudinal grooving and ridging of the nail plate, thinning of the nail plate,

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Vargas-Díez E, García-Díez A, Marín A, Fernández-Herrera J (May 2005). "Life-threatening graft-vs-host disease".

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Hellgren L (December 1970). "The prevalence of rheumatoid arthritis in different geographical areas in Sweden".

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McCartan BE, Healy CM (September 2008). "The reported prevalence of oral lichen planus: a review and critique".

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Siponen M, Kauppila JH, Soini Y, Salo T (November 2012). "TLR4 and TLR9 are induced in oral lichen planus".

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Lodi, Giovanni; Manfredi, Maddalena; Mercadante, Valeria; Murphy, Ruth; Carrozzo, Marco (28 February 2020).

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Sharma A, Białynicki-Birula R, Schwartz RA, Janniger CK (July 2012). "Lichen planus: an update and review".

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of the first intron of the interferon (IFN)-gamma promoter in patients with oral LP compared with controls.

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appearance to lichen planus (i.e., an area which resembles lichen planus, both to the naked eye and under a

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Friedman, Paula; Sabban, Emilia Cohen; Marcucci, Carolina; Peralta, Rosario; Cabo, Horacio (October 2015).

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Wang EH, Monga I, Sallee BN, Chen JC, Abdelaziz AR, Perez-Lorenzo R, Bordone LA, Christiano AM (Jul 2022).

314:) or, uncommonly, as a spontaneous, isolated eruption, usually on the extremities, and rarely on the face. 8371: 8338: 8011: 8001: 7996: 7938: 7865: 7821: 7717: 7712: 7498: 7328: 7323: 7298: 7144: 7075: 6902: 6811: 6729: 6456: 6264: 6222: 6132: 6109: 6095: 6058: 6053: 5998: 5898: 5810: 5126: 3791:

Duncan SC, Su WP (August 1980). "Leukoedema of the oral mucosa. Possibly an acquired white sponge nevus".

865: 386: 252: 6995: 6719: 8180: 8082: 7694: 7572: 7552: 7434: 7393: 7256: 7244: 7193: 6856: 6254: 6227: 6200: 6167: 5800: 5727: 5415: 4949: 4929: 1271: 939: 180: 6929: 2371: 913:(DIF) can be useful in patients with bullous lesions to differentiate the condition from an autoimmune 1270:, or if these are ineffective and the condition is severe, then systemic corticosteroids may be used. 8278: 7917: 7902: 7468: 7401: 7007: 6739: 6366: 6205: 5146: 4944: 4919: 4419:

Yu TC, Kelly SC, Weinberg JM, Scheinfeld NS (March 2003). "Isolated lichen planus of the lower lip".

1419:"Primary cicatricial alopecias are characterized by dysregulation of shared gene expression pathways" 1186:

An amorphous band of eosinophilic material at the basement membrane composed of fibrin or fibrinogen.

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Papules are arranged in a line (the "Blaschko line"). This pattern may develop secondary to trauma (

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This morphology is characterized by chronic, painful bullae and ulceration of the feet, often with

6610: 1560:(Version 3. ed.). North Melbourne, Vic.: Therapeutic Guidelines. 2009. pp. 254–55, 302. 8376: 8230: 8034: 7850: 7798: 7759: 7456: 7372: 7303: 7012: 6836: 6816: 6769: 6655: 6600: 6563: 6553: 6538: 6468: 6178: 6162: 5717: 5581: 5466: 5425: 5299: 5294: 5289: 5116: 4199: 3909: 3556: 3424: 3290: 3206: 3158: 3031: 2728: 2676: 2594: 2060: 2052: 2002: 1244: 906: 856: 671:

The second most common form and the most advance form of oral lichen planus, is characterised by

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represents a wide range of cutaneous disorders characterized by lichen planus-like skin lesions.

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Asch S, Goldenberg G (March 2011). "Systemic treatment of cutaneous lichen planus: an update".

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Reassurance that the condition is benign, elimination of precipitating factors and improving

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is the most common site for involvement. Symptoms are absent, and no treatment is necessary.

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Medication the patients are taking within the few weeks to months after drug initiation e.g.

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cause effect relationship between stress and the onset of oral LP has not been demonstrated.

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Oral lichen planus is relatively common, It is one of the most common mucosal diseases. The

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Panagiotopoulou N, Wong CS, Winter-Roach B (April 2010). "Vulvovaginal-gingival syndrome".

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Scully, C.; El-Kom, M. (1 July 1985). "Lichen planus: review and update on pathogenesis".

1247: 575:

or skin of the scrotum in males, and the vulva or vagina in females. Symptoms may include

231: 222:-like" appearance and can be classified by the site they involve, or by their morphology. 3804: 3587: 3261:"Downregulation of TLR-7 receptor in hepatic and non-hepatic patients with lichen planus" 1906: 1183:

with apoptotic keratinocytes (referred to as Civatte, colloid, hyaline, or cytoid bodies)

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This morphology is characterized by the presence of a few well-demarcated, white-bluish

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Cheng S, Kirtschig G, Cooper S, Thornhill M, Leonardi-Bee J, Murphy R (February 2012).

4015: 3887: 3844: 3827: 3699: 3646:"Nomenclature and classification of potentially malignant disorders of the oral mucosa" 3622: 3508: 3476: 3443: 3062: 2917: 2884: 2840: 1851:

Cheng S, Kirtschig G, Cooper S, Thornhill M, Leonardi-Bee J, Murphy R (February 2012).

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A lichenoid (band-like) lymphocytic infiltrate immediately subjacent to the epithelium.

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The clinical evaluation should include a patient history that assesses the following:

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McCartan BE (July 1995). "Psychological factors associated with oral lichen planus".

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Oral LP usually resolve upon removal of the trigger, as is characteristics of oral LP

725: 490: 418: 3913: 3294: 3162: 3035: 2769: 2752: 2732: 2680: 2598: 1650:

Meredith A. Olson; Roy S. Rogers III; Alison J. Bruce (2016). "Oral lichen planus".

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been associated with erythematous, erosive, ulcerative, or lichenoid oral lesions.

771: 535: 461: 3980: 1046:(with or without eosinophils) and perivascular inflammation favor this diagnosis. 409:

Occasionally, lichen planus is known to occur with other conditions. For example:

377:

in sun-exposed areas and flexural folds. This is a rare variant of lichen planus.

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Axéll T, Rundquist L (February 1987). "Oral lichen planus--a demographic study".

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Weedon, David (2010), "The lichenoid reaction pattern ('interface dermatitis')",

2582: 8313: 8303: 8293: 8210: 8205: 8136: 7210: 7171: 6990: 6866: 6826: 6694: 6615: 6595: 5883: 5708: 5410: 5076: 4845: 4815: 4380:"COX-2, MMP-7 expression in oral lichen planus and oral squamous cell carcinoma" 1977:

Wagner G, Rose C, Sachse MM (April 2013). "Clinical variants of lichen planus".

1434: 1313: 1298: 1283: 1137: 1125: 1099: 1095: 1039: 902: 898: 891: 817: 791:

and composite) or drugs can cause hypersensitivity reaction and lead to oral LP.

778:

Several potential triggers of oral LP have been proposed over the years, mainly

672: 637: 588: 572: 558: 436: 264: 145: 50: 4834: 4670: 1598: 997:

The history of preceding hematopoietic cell transplant is helpful for diagnosis

759:

T cells, has been proposed. Upregulation of intercellular adhesion molecule-1 (

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Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology

3969:

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology

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infection. These rupture easily and they leave an ulcerated, painful surface.

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that affects the skin, nails, hair, and mucous membranes. It is not an actual

3574:

Eisen D (June 1992). "The oral mucosal punch biopsy. A report of 140 cases".

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Le Cleach L, Chosidow O (February 2012). "Clinical practice. Lichen planus".

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and other autoimmune blistering diseases may present with oral erosions and

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Agha R, Mirowski GW (May 2010). "The art and science of oral examination".

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Oral and maxillofacial medicine : the basis of diagnosis and treatment

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Alam F, Hamburger J (May 2001). "Oral mucosal lichen planus in children".

2049:. If this is an intentional citation to a retracted paper, please replace 1775: 1513: 8151: 8102: 7870: 7623: 7604: 7584: 7405: 7283: 7227: 6473: 5913: 5535: 5515: 5451: 5405: 5347: 5284: 5226: 5046: 4995: 4924: 2885:"Interventions for treating oral lichen planus: corticosteroid therapies" 1216: 958:, etc. to evaluate for the possibility of an oral lichenoid drug eruption 947: 852:

the release of proinflammatory mediators and proteases by mast cells, and

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overlap syndrome, sharing features of lichen planus and lichen sclerosus.

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Alabi GO, Akinsanya JB (June 1981). "Lichen planus in tropical Africa".

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of lichen planus in worldwide population is in the range of 0.2% to 5%.

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are being targeted as foreign antigens by activated T cells, especially

636:), is a form of mucosal lichen planus, where lichen planus involves the 8237: 8195: 7880: 7840: 7734: 7608: 7397: 6764: 5712: 5566: 5476: 5395: 5382: 5332: 5261: 4985: 4980: 4975: 2095:

Bolognia, Jean L.; Jorizzo, Joseph L.; Rapini, Ronald P., eds. (2008).

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keratotic papules and erosions with a bizarre configuration can occur.

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identification of clinical findings that suggest another diagnosis.

2949:(3rd ed.). Edinburgh: Churchill Livingstone. pp. 192–99. 628:

of non-erosive lichen planus in the left buccal mucosa (left cheek)

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It is found that cutaneous lichen planus does not carry a risk of

1157: 1086: 619: 596: 534: 460: 452: 435: 4157:"Lichen Planus: Practice Essentials, Background, Pathophysiology" 4101:"Interventions for erosive lichen planus affecting mucosal sites" 2157:(6th ed.). New York, NY: McGraw-Hill. pp. 366, 470–71. 1853:"Interventions for erosive lichen planus affecting mucosal sites" 813:

T cell-mediated cytotoxicity in oral LP is described as follows:

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areas of the skin. This is also known as "inverse lichen planus".

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Idrees, M; Kujan, O; Shearston, K; Farah, CS (25 January 2020).

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is present in around 10% of individuals with nail lichen planus.

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Warnakulasuriya S, Johnson NW, van der Waal I (November 2007).

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James, William D.; Elston, Dirk M.; Berger, Timothy G. (2011).

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The cutaneous manifestations resemble idiopathic lichen planus.

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This morphology is characterized by hyperpigmented, dark-brown

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of sufficient depth to the mid dermis is usually significant.

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Lichen planus on the lips and the lateral border of the tongue

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perturbations in the innate immune response that may involve

1676:(11th ed.). Hamilton, Ont.: BC Decker. pp. 89–97. 1050:

Oral lichenoid contact reaction (allergic contact mucositis)

1703:(2nd ed.). London: Manson Publishing. pp. 66–72. 365:

sequelae evident. This is a rare variant of lichen planus.

109: 103: 86: 80: 3129:"Lichen planus and lichenoid reactions of the oral mucosa" 2699:"Lichen planus and lichenoid reactions of the oral mucosa" 2396: 1312:

Due to the possibility that oral LP may increase risk for

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