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Instructor: Dr. Heddie Sedano
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LICHEN PLANUS: LECTURE (p. 4)


FIG6. Another example of erosive LP of the gingiva showing areas of desquamation and white lacing.
FIG7. Erosive LP of the palatal and gingival mucosa. Again note the white striations and the denuded areas. This patient complained of intense pain while drinking alcohol or citric juices.
Oral hygiene is generally poor because tooth brushing is very painful and aggravates the process of erosion. Erosive LP, in any intraoral location, is clinically almost always indistinguishable from other erosive-ulcerative diseases of the oral mucosas. The differential diagnosis should include: pemphigus vulgaris, mucous membrane pemphigoid, linear IgA disease, candidiasis and discoid lupus erythematosus. A biopsy should be taken from the peripheral areas of the lesion and be submitted for routine pathological examination as well as direct immunofluorescent studies in order to establish the proper diagnosis. Patients with erosive LP should be monitored once a year in order to detect early malignant transformation.

FIG8. Erosive lichen planus of the tongue. Here interlacing, plaque formation and erosion are identified. The patient complained of a burning sensation.
FIG9. Extreme example of erosive LP of the tongue. This case was successfully treated with systemic steroids.
Other clinical varieties of LP are occasionally seen such as atrophic LP which presents with reticulation on an erythematous base and might actually represent the evolution of the reticular variety into the erosive variety. This is a frequent appearance of gingival LP. A seldom seen variety is known as bullous LP characterized by the formation of bullae which very rapidly rupture leaving areas of erosion and ulceration, thus becoming an erosive LP.
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