Lichen Planu Vani

8/7/2019 Lichen Planu Vani

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A DIAGNOSTICDELIMA


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INTRODUCTION

Lack of clinico pathologic correlation in thediagnosis of OLP based on the presentlyavailable diagnostic criteria herein certainsuggestions & modifications have beenmade.

OLP is regarded as a clinicopathologic

diagnosis based on a combination of clinical& histopathologic criteria

Studies are done to correlate between clinical& histo atholo ic features of OLP.


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LICHEN PLANUSChronic mucocutaneous disease of

unknown etiologyEtiopathogenesisImmunologically mediated processthat microscopically resembleshypersensitivity reaction.


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C/F : Female predilection (>40yrs)

Bilateral symmetrical white keratotic striae.

TYPES :

Keratotic Vesiculobullous A tropic E rosive

Reticular

Annular

Papular

Linear

Floral

Plaque like


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H ISTOPAT H OLOGYHyperkeratosis

Basal cell degeneration

T-Lymphocytic infiltration

Rete ridges (saw tooth)


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K ERATOTIC OLP


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DIFFERENTIAL DIAGNOSIS

Lichenoid drug reaction

Lichenoid Dysplasia

Lupus erythematosis

White Sponge Nevus

Hairy Leukoplakia

Cheek Chewing

Graft Versus Host Disease

Candidiasis


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PLAQUE LI K E LIC H EN PLANUS

Idiopathic Leukoplakia

Squamous cell carcinoma

EROSIVE OR ATROP H IC LIC H EN PLANUS

Cicatricial Pemphigoid

Pemphigus Vulgaris

Chronic Lupus Erythematosis

Contact Hypersensitivity

Chronic Candidiasis


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LIC H ENOID REACTION

Presence of lesion resembling Lichen Planus mainlyon the buccal mucosa associated with ingestion of some category of medications & presence of exogenous materials in the oral cavity.


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LIC H ENOID DYSPLASIA

K rutchoff & Eisenberg

A lesion that histopathologically revealedcharacteristics of Oral Lichen Planus and additional

presence of dysplastic features within the overlyingepithelium .


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WHO Diagnostic criteria for OLP & OLL

Clinical CriteriaPresence of bilateral more or less symmetrical

lesions.Presence of a lace like network of slightly raisedgray white linesErosive,Atrophic,Bulbous & Plaque type lesions

are only accepted as a subtype in the presence of reticular lesions elsewhere in the oral mucosa.In all other lesions that resemble OLP but do notcomplete the aforementioned criteria the term

clinically compatible w ith should be used.


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HISTOPATHOLOGICALCRITERIA

Presence of well defined band like zone of cellular infiltration that is confined to the superficial part

of the connective tissue consisting mainly of lymphocytesSigns of liquefaction degeneration of the basal celllayer

Absence of epithelial dysplasiaWhen histopathological features are less obviousthe term histopathologically compatible w ithshould be used


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FINAL DIAGNOSIS OF OLP &OLL

C linical as histopathological criteria has to be included

OLLC linically typical of OLP but H istopathologically only compatible w ith OLPH istopathologically typical of OLP but

clinically only compatible w ith OLPC linically compatible w ith OLP &H istopathologically compatible w ith OLP


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CONCLUSIONThere is a lack of Clinicopathologiccorrelation in the diagnostic assessment of OLP.Modified WHO definition of OLP &OLL includes both clinical as well ashistopathological criteria thus may

eliminate confusion for diagnosis


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