Dermatology - Oropharyngeal Lichen Planus

Dermatology - Oropharyngeal Lichen Planus 
Lichen planus manifestations in the oropharynx

Approximately 40-60% of individuals diagnosed with lichen planus experience involvement in the oropharynx. Lichen planus is a dermatosis characterized by acute or chronic inflammation. It often occurs in individuals between the ages of 30 and 60, with a higher frequency in women. Idiopathic is the most common cause, however cell-mediated immunity can have a significant impact.
The onset can be either sudden (occurring within a few days) or gradual (taking place over several weeks), and the lesions persist for a duration of months to years. Lesions can be either asymptomatic or pruritic, and mucous membrane lesions are particularly unpleasant, especially when they are ulcerated. Postinflammatory hyperpigmentation is a frequent occurrence. Lesions may appear on the lips and in a linear pattern following trauma, known as the Koebner or isomorphic phenomena.
Abnormalities
Skin lesions exhibit the following characteristics: they have a color ranging from pink to purple, they are shiny, they cause itching (pruritic), and they have a polygonal shape. These lesions are in the form of papules, which have a diameter between 1 and 10 mm. The oropharyngeal cavity has milky-white papules known as Wickham striae. These striae are characterized by a reticulate pattern of lacy-white hyperkeratosis, leukoplakia, or atrophy. The tongue and buccal mucosa may have superficial erosions covered by fibrin clots, which can cause pain. Additionally, intact blisters and bright red gingiva may be present.

The diagnosis is established through clinical examination and subsequently confirmed via biopsy. The differential diagnosis for oropharyngeal lesions encompasses leukoplakia, candidiasis, lupus, trauma, secondary syphilis, pemphigus vulgaris, and bullous pemphigoid.


Apply topical glucocorticoids with occlusion for skin lesions and use intralesional triamcinolone (3 mg/mL) for lesions in the mouth and lips. For very symptomatic oral lesions, use cyclosporine and tacrolimus solutions as a mouthwash.
Systemic
For very resistant and widespread instances, a daily oral dose of 5 mg/kg of cyclosporine can effectively bring about a quick improvement, with a minimal likelihood of the condition returning. Oral prednisone is beneficial for those experiencing symptomatic pruritus, painful erosions, dysphagia, or cosmetic deformity. An abbreviated, gradually decreasing regimen is recommended: 70 mg as an initial dose, followed by a daily reduction of 5 mg. Retinoids, specifically Acitretin, at a dosage of 1 mg/kg per day, can be beneficial as a supplementary treatment in severe instances. However, additional topical treatment is necessary. Photochemotherapy can be beneficial for those who do not respond well to both topical and systemic treatments.