Orale lichen planus - een diepgaande gids voor huidziekten

Diagnosis and management of oral lichen planus – Review

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OLP is defined as a common chronic immunological mucocutaneous disorder that varies in appearance from keratotic to erythematous and ulcerative (Wilson 1896)[6]

Lichen planus is a relatively common disorder of the stratified squamous epithelia (Duske and Frick, 1982: Skully and El-kom 1985)[7,8]

OLP as a relatively common chronic inflammatory disorder affecting the stratified squamous epithelia[7]

Lichen planus is a common disorder in which auto-cytotoxic T-lymphocytes trigger apoptosis of epithelial cells leading to chronic inflammation. OLP can be a source of severe morbidity and has a small potential to be malignant (Scully et al. 2008).[8]

HEMATOLOGICAL INVESTIGATIONS

Histopathology of oral lichen planus

It was First described by DUHRENILL in 1906 and later revised by SHKLAR in 1972:[25,27]

Max Joseph spaces which are histological clefts between basement membrane lamina and propria interface caused due to liquefaction necrosis of basal layer

Civatte/hyaline/cytoid/colloid bodies which are Degenerating keratinocytes at the epithelial connective tissue interface

An eosinophillic band may be seen just beneath the basement membrane and represent fibrin covering lamina propria.

History and Physical

There are six clinical subtypes of OLP: reticular, papular, plaque, atrophic, erosive, and bullous.[30] These may be present either individually or in combination with each other, and the classification is usually based on the predominant subtype manifested.[21]

An accurate diagnosis of OLP must be based on thorough history taking, clinical examination, and histopathologic findings. In patients presenting with the characteristic reticular form of OLP, the clinical presentation alone can be sufficiently diagnostic. However, an oral biopsy is still advisable to confirm the clinical diagnosis and to rule out evidence of dysplasia and malignancy.[29]

For patients who present with desquamative gingivitis, direct immunofluorescence (DIF) may be necessary to rule out autoimmune vesiculobullous diseases that share similar clinical features.[19]

WHO 1978 – DIAGNOSTIC CRITERIA[27,28]

In 1978, WHO formulated diagnostic criteria for OLP, which included both clinical and histopathological features for consideration.

Clinical criteria

White papular-, reticular (lace-like network of slightly raised gray-white lines), annular- or plaque-type lesions

Histopathological criteria

Presence of a well-defined band like zone of cellular infiltration that is confined to the superficial part of the connective tissue, consisting mainly of lymphocyte

Eisenberg's criteria[25,26,27]

He considered some essential criteria for diagnosis that includes:

Band-like lymphocytic infiltrate at the epithelial–stromal junction, with obfuscation of the basal cell region

He suggested some features to be excluded:

Atypical cytomorphologies (suggestive of epithelial dysplasia) – hyperchromasia, prevalent dyskeratosis and increased mitotic figures

Heterogeneous population of inflammatory infiltrate, deeper submucosal extension of infiltrate beyond superficial stroma and perivascular infiltration.