Sankara Subramanian
Sri Ramachandra Medical College & Research Institute, Sri Ramachandra University
India
Title: Oral lichen planus
Biography
Biography: Sankara Subramanian
Abstract
Oral lichen planus is a chronic inflammatory condition that affects the oral mucous membranes with a female predominance and peak presentation during fourth decade. Multidisciplinary approach is required for successful management of oral LP. T cell mediated auto immune process in which autocytotoxic CD8+ T cells trigger apoptosis of oral epithelial cells. Systemic drugs, contact allergens in dental materials, trauma, bacterial or viral infections may unmask the antigen. Upregulation of heat shock protein (HSP) has been demonstrated. Increased secretion of Th 1 type cytokines such as IL-2, IFN gamma and IL-12 leads to basal cell lysis. The causative factors are drugs, contact allergens, infections, stress and genetics. Oral lesions present as whitish lace like network, buccal mucosa is most frequently affected. The types of LP are: Reticular, papular, plaque, erosive and atrophic. The oral LP presents with pain and burning sensation. Diagnosis of oral LP includes clinical and histopathological criteria. Examination of skin, hair and nails is essential. Work up includes CBC, sugars, lipid profile, LFT, HCV screening, buccal smear for candida, mucosal biopsy and direct immunofluorescence if necessary. Multidisciplinary approach involving dermatolgists, dentists, psychologists helps attain holistic management. Treatment of OLP includes topical steriods, cyclosporine, calcineurin inhibitors, retinoids in ora base & in difficult cases, systemic drugs like steroids, immunosuppressive agents, dapsone , targeted phototherapy. Excision of resistant plaques and lesion showing atypia may be undertaken. Treatment of oral LP aims at resolution of symptoms, lesions, reducing the risk of cancer, prolonging symptom free intervals to improve the QOL.