European S1 guidelines on the management of lichen planus: a cooperation of the European Dermatology Forum with the European Academy of Dermatology and Venereology

Abstract

Lichen planus (LP) is a chronic inflammatory and immune-mediated disease that affects the skin, hair, nails and mucous membranes. Although there is a broad clinical spectrum of lichen planus manifestations, the skin and oral cavity remain the major sites of involvement. A group of European dermatologists with a long-standing interest and expertise in lichen planus has sought to define therapeutic guidelines for the management of patients with LP. The clinical features, diagnosis and possible medications that clinicians can use, in order to control the disease, will be reviewed in this manuscript.The revised final version of the lichen planus guideline was passed on to the European Dermatology Forum (EDF) for a final consensus with the European Academy of Dermatology and Venereology (EADV).

Oral lichen planus and its recent management: A review

“…HPV16, HSV17), & changes in the mucosal microbioma (e.g. Candida species, various other bacteria) 1 Medical conditions such as auto immune disease, diabetes, chronic liver disease, intestinal diseases, increases cholesterol level, hypertension and infections can also cause onset of oral lichen planus 13. Systemic medicines can also contribute to the production of oral lichenoid reactions (OLR) and lichen planus, such as nonsteroidal antiinflammatory drugs, antihypertensives, and oral hypoglycemics. Amalgam, copper , and nickel from dental restorative content can also be related to the localization of OLR in some patients 14 The table below briefly describes some of the etiological features of oral lichen planus.…”

“…While various studies have shown that OLP is a widely recognized chronic inflammatory autoimmune responsedriven disorder, the precise pathogenesis remains unknown 1,5,6,[15][16][17][18] . Some researchers found that emotional stress, infection and hypersensitivity contribute to OLP onset 1,6,19 . There has also been reported genetic vulnerability by haplotypes, such as HLA -A3, -A5, -A28, -B8, -B16, -Bw35, -B7, -B18, -Aw19, -Cw8 associated with different variants of LP 1 .…”

“…Some researchers found that emotional stress, infection and hypersensitivity contribute to OLP onset 1,6,19 . There has also been reported genetic vulnerability by haplotypes, such as HLA -A3, -A5, -A28, -B8, -B16, -Bw35, -B7, -B18, -Aw19, -Cw8 associated with different variants of LP 1 . OLP is considered a T cell-mediated autoimmune disorder in which apoptosis of basal epithelial cells is caused by clusters of differentiation 8 (CD8)+ T cells.…”

“…Lichen planus is a distinct condition with normal colour, morphology and distribution, representing skin and mucosal lesions. LP affects about 0.5-2% of the general population , especially women, and occurs most frequently in middle age 1,20 Usually, numerous lesions occur in the disorder, often of bilateral and symmetric distribution.The classification of Andreasen distinguishes six OLP clinical manifestations, including reticular, plaquelike, atrophic (erythematous), erosive-ulcer and erosive 5,10 It may occur alone in the mucosa of the oral cavity, alone in the skin, concurrently in the oral cavity and skin, or in other extra-oral locations, such as the scalp, oesophagus, nails, and genitals.Erythematous lesions are frequently associatedwith reticular lesions, while both reticular anderythematous lesions are associated with erosive lesions in most cases. In addition, within the mouth, in the buccal and lingual mucosa and on the dorsal tongue, lesions are prominent 9 .…”

“…OLP diagnosis can be made clinically in many cases , particularly when viewed in reticular form.Leukoplakia subtype, erythroplakia, lichen sclerosis,pemphigoid lichen planus, lupus erythematosus, linear IgA syndrome, chronic ulcerative stomatitis, pemphigoid mucous membrane, and also the second stage of syphilis. A biopsy can be useful in such cases for histopathological evaluation and, if possible, for immunohistochemical analysis 1,16…”