Oral lichen planus

Introduction to oral lichen planus Oral lichen planus is an inflammatory disease affecting the surface of skin and mucous membranes. It is speculated that it may be caused by autoreactive T lymphocytes mediated damage to epithelial basal cells. Clinical and histopathological findings are very similar to graft-versus-host responses. 10% to 50% of patients with lichen planus have oral damage. As a kind of precancerous lesion, the disease continues to develop, and the possibility of cancer is large. According to the different lesions, it may develop into different types of oral cancer. basic knowledge The proportion of illness: 0.003% Susceptible people: no specific population Mode of infection: non-infectious Complications: oral cancer

Oral lichen planus etiology

Drug factors (75%):

The cause of lichen planus is unknown. From the clinical and basic research, streptomycin, isoniazid, chlorinated phenyl sulfonate, and chlorbutazone may cause lichen planus rash or promote the disease.

Other factors (15%):

Many factors have been found. At present, it is generally believed that the onset may be related to neuropsychiatric disorders, viral infections or autoimmunity. There are reports of the same patients in the family, and whether there is no evidence related to heredity.

Oral lichen planus prevention

1. Maintain oral hygiene and eliminate the irritating effects of local factors.

2. Establish a healthy lifestyle and actively prevent and treat systemic diseases.

3. Pay attention to adjust the diet structure and nutritional mix, quit smoking and spicy food.

4. Maintain an optimistic and cheerful state of mind and ease anxiety.

5. Regular oral examination and health care.

Oral lichen planus complications Complications, oral cancer

As a kind of precancerous lesion, the disease continues to develop, and the possibility of cancer is large. According to the different lesions, it may develop into different types of oral cancer.

Oral lichen planus symptoms common symptoms oral mucosa diffuse hyperemia oral mucosal ulcer itching discoid erythematous papules oral refractory white flakes hair loss molars

The oral mucosa is basically the same as the microscopic lesions, which can be summarized as: hyperkeratosis and parakeratosis, necrotic liquefaction of basal cells with granular hypertrophy, and a large amount of lymphocyte infiltration under the basement membrane. In addition, circular eosinophilic gels (Givatte bodies) are sometimes seen in the spinous layer, basal layer or connective tissue, and their volume is smaller than that of spine cells, but the gelatinous body can also be seen in discoid lupus erythematosus. In many diseases, the detachment of desmosome and hemidesmosome of basal cells can be seen under electron microscope, which leads to the infiltration of a large number of inflammatory cells, and the formation of subepithelial vesicles in the gaps separating basal cells from the basement membrane. It may become an antigen and cause an autoimmune reaction, so under direct immunofluorescence, fluorescence generated by deposition of immune complexes sometimes occurs in the basement membrane region. In addition, changes in the basement membrane, irregularities, thickening, rupture and re-formation can be seen; basal membrane rupture causes inflammatory cells to enter the spinous layer, and the colloids in the spinous layer may be degenerated by macrophages or Dead epithelial cells.

1. The lichen planus in the mouth is most likely to appear in the buccal mucosa, followed by the gums, the tongue, the lower lip, the bottom of the mouth and the sputum. Only the appearance of Wickham can diagnose oral lichen planus.

2. Linear or reticular type of lichen planus, which is characterized by irregular linear or blue-white ridges, multiple buccal mucosa, and different types of papular lichen planus, scattered or fused, with clear white papules. Careful observation, small streaks may appear around the papules, and another manifestation is that multiple homogeneous plaques connected to the Wickham pattern constitute plaque-type lichen planus, and plaque-type patients have higher smoking frequency, so it can be assumed that plaque type Lichen planus is caused by lichen planus and mucosal leukoplakia. Atrophic or ulceration mainly occurs in patients over 40 years old. Irregular shallow ulceration occurs on dry, red and shiny mucous membranes. Bullous type is rare, bullous usually It is developed on the basis of reticular or linear damage. After the blister ruptures, it forms a shallow ulcer, which may cause 2 infections.

3.28% to 91% of patients complained of symptoms of oral lichen planus damage, and atrophic and ulcerated lichen planus had pain.

4. Oral lichen planus can develop into carcinoma in situ, especially atrophic and erosive, with a high incidence of 1%, and 1% of oral lichen planus is associated with leukoplakia.

During the diagnosis process, efforts should be made to find skin lesions. Biopsy is helpful for diagnosis, but the basal liquefaction type and serrated epithelium type are not as noticeable as on the skin.

1. Skin damage Lichen planus is one of many mossy skin diseases. The damage is characterized by a flat, shiny, light purple-red polygonal papule. The papules are mung bean-sized, the edge is clear, the texture is hard and dry, and the fusion is like moss. The damaged area is rough, and the skin folds are visible between the papules. Because of the itching, there are many scars. The paraffin oil is applied to the surface of the papules. Under the magnifying glass, the fine white lines can be seen, which is called Wickham pattern. The treatment effect of skin damage is generally better. The mucosa is excellent.

2. The damage of nails and (or) nails is often symmetrical, but the ten fingers (toe) are also rare in patients with sputum. The body is thin and dull, there is a depression when pressed, and sometimes the red needle tip is small in the nail bed. Point, pressure examination of the pain, the surface of the body can be expressed as fine scale longitudinal groove, point gap, cutting surface (like a plane cut off by a sharp blade and flat), severely pointed, nail damage can cause the body to fall off, but also Ulcer necrosis occurs, and in some cases, hair loss can occur in addition to nail damage.

3. The main characteristics of oral mucosal damage are pearlescent white stripes, white lines can be extended to all aspects, the whole line is not "cut" by red lines, and white lines can be interwoven into a network when dense, and can be dendritic when rare. It is a single line or a ring, although there are many types, but the classification has no important clinical significance. The damage often has obvious bilateral symmetry. The mucous membrane is soft and the elasticity is normal, but it has a rough feeling and mild irritation.

(1) reticular damage: more common in the mucous membrane area and vestibular groove, often spread from the back to the front, the flexibility and elasticity of the mucosa in the damaged area is basically normal, the patient consciously has a rough mucosal surface, and when the lips are active, they are pulled and eaten. Mild irritating pain, etc., which is also the difference between white keratosis, because the main pathological changes of lichen planus are basal cell liquefaction denaturation and a large number of inflammatory cell infiltration in the lamina propria, so in the dense area of white streaks, especially in the vestibular ditch and cheek More mucosal areas are congested, and subepithelial vesicles are formed. The blister is easily broken and quickly becomes superficial erosion. Usually, after local treatment, erosion can heal and white lines reappear, so this limitation is only the disease. A staged manifestation, rather than a specific type of the disease, the rare areas of white streaks usually less erosive, single lines can occur in the vestibular sulcus, the mouth and the mouth of the tongue, the lip red and the attached sputum, the ring is occasionally seen in Buccal mucosa.

(2) papules: like the size of a needle, micro-long, occasionally seen in the buccal mucosa with white lines, but should not be confused with Fordyce disease, because the two can exist at the same time, the ectopic sebaceous gland is light Yellow granules can be clustered or scattered. Except for very superficial, they are generally hidden under the mucosa and have no symptoms. The lip red part is also a good area for ectopic sebaceous glands. Generally, the upper lip is more common in the lower lip.

(3) Plaque: more common in round or elliptical shape, often located in the middle or both sides of the tongue, basically symmetrical, but also unilateral, the nipple of the damaged area disappears and is flat, and the square type is occasionally seen in the history of smoking. The buccal mucosa and/or sputum is actually a rare white keratosis, so the plaque gradually disappears and the white lines reappear after quitting.

(4) vesicles: generally miliary, more common in soft palate, but can also occur in other parts, blister is easy to rupture, and reappears at night.

(5) erosion: the erosion type is common, the range is quite wide, and it can be spread throughout the oral mucosa. Although, in some areas, white-like lesions can still be revealed faintly. Because there is no typical performance, it cannot provide a clinical basis for diagnosis. Erosion often shows residual blister wall, like "epidermal exfoliation". This clinical manifestation of exfoliation can be seen in a variety of inflammatory diseases (pemphae, pemphigus, etc.), so the old name is "exfoliative gingivitis" Nowadays, it is not an independent disease. This type is often confrontational for antibiotics and immunosuppressive therapy. It is necessary to carry out a comprehensive systematic examination to avoid delay diagnosis and treatment.

4. Genital mucosal damage is often dark red round or oval plaque, white reticular damage can be seen on the surface, prone to erosion.

Oral lichen planus examination

Histopathological examination: epithelial hyperkeratosis or atrophy, active basal cell degeneration, colloidal bodies in the epithelium and nodules, dermal layer may be mainly infiltrated by monocytes, lymphocytes migrate into the epithelial layer, thus The boundary between epithelium and connective tissue is unclear. In addition to the majority of pulp cells in the gingival lesion biopsy, other skin lesion biopsy does not occupy the majority. Sometimes, the basement membrane exhibits glassy degeneration, and PAS staining is more obvious.

Immunohistochemical staining: Immunohistochemical staining showed that most of the immunoglobulins were deposited on the gelatinous bodies, a few deposited on the cell surface, and cellulose deposits were observed in the basement membrane. The dermis was mainly infiltrated by CD4 lymphocytes, and the epithelial and basal areas. CD8 lymphocyte infiltration, epithelial Langerhans cell number is normal, but more pleomorphic and express HLA class II antigen, oral lichen planus keratinocytes express HLA class II antigen, but can not be associated with non-specific gingivitis, lupus erythematosus In contrast to Candida lipitis, the Langerhans cell antigenicity of drug-related lichen-like rashes is different from that of idiopathic lichen planus, even though their clinical manifestations and histopathological findings are very similar.

Diagnosis and identification of oral lichen planus

Lichen planus should be distinguished from the following diseases:

1. Oral red spot disease (referred to as red spot, oral erythema). Red spot is a kind of red oral mucosal precancerous lesion, very similar to the precancerous dermatitis - Bowen disease, both on histopathological land, sea and air The changes are often difficult to distinguish. They are called red spots in order to avoid being literally mixed with benign inflammatory erythema (macule) to show the difference between the two.

The common mucositis is a general term for red benign mucositis. Trauma, infection, drug eruption and other causes can cause inflammatory reactions in any part of the mouth. This inflammatory reaction is also commonly called erythema, the erythema is dark red, there is no specific blood red, the pain is more obvious, and the course of disease is short. For the localized damage of suspected red spot, corticosteroids such as inflammatory and sedative can be injected under the damage. 2 times a week, if there is no sign of regression within 2 weeks, a physical examination should be performed.

2. Discoid lupus erythematosus women are more common, damage often occurs in the lips, buccal mucosa, tongue back, mouth and tongue and other parts of the tongue, skin lesions are more common in the head and face, mucosal damage characterized by central atrophy, peripheral white or yellow White and hard plaques with irregular edges but clear boundaries, and lesions can be used as a reference for identification.

The identification of the above diseases and lichen planus can also be confirmed by histological examination: red spot damage is the disappearance of the keratinized layer, only 2 to 3 layers of spine cells, nucleoplasmic ratio changes, nuclear deep staining, etc.; epithelial damage caused by lupus erythematosus Excessive keratinization, but hyperplasia is not obvious; leukoplakia has obvious abnormal proliferation of epithelium; epithelium of lichen planus has hyperkeratosis or parakeratosis, sometimes atrophy, basal cell arrangement disorder, liquefaction or necrosis, a large number under the basement membrane Lymphocyte infiltration.

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