44. LICHEN PLANUS. CHEILITIS. CORNU CUTANEUM. KERATOACANTHOMA.Melanoplakia

define lichen planus and areas that it affects

a chronic, autoimmune inflammatory disease

can affect the skin, mucous membranes, scalp and nails

lichen planus typically affects whom?

females more prone than males

around 30-60y/o

what is the etiology of lichen planus?

autoimmune

females more prone than males

around 30-60y/o

genetics

dental materials- amalgam and gold

drugs- antimalarials nsaids cardiovascular

infectious agents- HepC HIV

allergies

stress

diabetes

what are the types of lichen planus?

PAPER

Papular

Atrophic

Plaque like

Erosive

Reticular

explain the presentation of the papular lichen planus

rare

small, white raised papule

fine white striations at the borders

explain the presentation of atrophic lichen planus

red lesion

burning sensation and pain exacerbated by trauma hot spicy acific foods

explain the presentation of the plaque lichen planus

resembles leukoplakia dorsum tongue and buccal mucosa most affected

homogenous white lesion

typically in smokers

explain the presentation of the erosive lichen planus

irregular erosion and ulceration

fibrinous plaque with pseudomembranous cover

burning sensation and pain exacerbated by trauma hot spicy acific foods

explain the presentation of the reticular lichen planus

most common type

fine white lace appearance (Wickham striae)

symmetrical, bilateral

which type of lichen planus is most common to turn malignant?

atrophic or erosive and in cases of lesison on the lateral border of tongue

how do we diagnose lichen planus?

Wickham striae are pathognomic

atrophic and erosive type need biopsy

direct immunofluorescence help distingush from pemphigus vulgaris, bullous dermatitis

what is the treatment for lichen planus?

1. topical treatment

- corticosteroids

- retinoids

2. systemic treatment

- corticosteroids when topical haven't worked

3. surgery

- cryotherapy

- surgical excision

- carbon dioxide laser

differential diagnosis of lichen planus

erythoplakia

luekoplakia

candidasis

scc

what is actinic cheilitis?

inflammation of lips due to sun exposure- potential to be malignant

where is actinic cheilitis typically seen?

surface area of the lower lip due to the anatomic proximity.

what is the etiology of actinic cheilitis?

solar rays

tobacco use

poor oral hygiene

ill fitting dentures

higher prevalance in mena

explain the clinical appearance of actinic cheilitis (early + late )

early stages

- erythema

- oedema

late stages

- diffuse scaling

- thickened epithelium

- small grey- white plaques

-linear fissures

how do we diagnose actinic cheilitis?

biopsy - evaluate level of dysplasia

how do we treat actinic cheilitis?

5-fluoracil

scalpel vermillionectomy (cutting of the vermillion)

chemical peel

cryosurgery

carbon dioxide laser

photodynamic therapy

what is Cornu cutaneum?

this is an unusual keratin overgrowth which has a cone appearance

what is the treatment for Cornu cutaneum?

surgical excision or cryo-/ CO2 laser therapy

what is keratoacanthoma?

low grade abnormall cell growth originating from hair follicles or pilosebacous glands

rapidly growing "volcano-like" nodule with a central keratotic plug

keratoacanthoma etiology

skin that recieves heavy exposure to sunlight

keratoacanthoma growth pattern

Dome shape

Symmetrical structure

Surrounded by inflamed skin with a smooth wall

skin has kertainised scales

when untreated what occurs to keratoacanthoma?

Keratoacanthoma can grow as squamous cell carcinoma.

Keratoacanthoma is treated how ?

surgical excision

What is melanoplakia?

oral pigmentation

Melanoplakia etiology

• amalgam

• Peutz-Jeghers syndrome

• smoking

clincial signs of melanoplakia

variant in colour of skin - blue black light brown