Problems of diagnostics of oral lichen planus

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Abstract

Lichen planus is a disease most commonly found in both dermatological and dental practice. The etiology of this dermatosis is not fully understood. As a rule, with lichen planus, the organs of the gastrointestinal tract, cardiovascular, nervous, endocrine and other systems are affected. The disease can develop against the background of strong psychoemotional stress. Differential diagnosis of lichen planus is performed with leukoplakia, autoimmune pemphigus, candidiasis and lupus erythematosus.

The authors present their own clinical observation of a patient with a lichen planus of the oral mucosa, in whom a diagnostic error led to the series of unsuccessful hospitalizations, examinations, surgical interventions against the background of a gradual aggravation of the mental state.

The interest of this clinical observation is that in the case of diagnosis of lichen planus of the oral mucosa, a complete examination of the skin and all mucous membranes is necessary in order to identify the elements characteristic of this disease. Of particular importance is a biopsy with histological and immunohistochemical examination before the start of therapy. With a prolonged course of the disease, the ineffectiveness of invasive therapies requires timely administration of systemic glucocorticoids to achieve remission. Prolonged and persistent course of lichen planus of the oral mucosa can lead not only to the transformation of the process, but also to the development of psychogenic reactions.

The article shows the importance of a tandem between a dermatovenerologist, a dentist and a psychiatrist for the effective care of patients with lesions of the oral mucosa with lichen planus.

About the authors

Olga V. Grabovskaya

I.M. Sechenov First Moscow State Medical University

Email: olgadoctor2013@yandex.ru
ORCID iD: 0000-0002-5259-7481
SPIN-code: 1843-1090

MD, Cand. Sci. (Med.), Professor

Russian Federation, Moscow

Lyailya N. Kayumova

I.M. Sechenov First Moscow State Medical University

Email: avestohka2005@inbox.ru
ORCID iD: 0000-0003-0301-737X
SPIN-code: 4391-9553

MD, Cand. Sci. (Med.), Assistant Lecturer

Russian Federation, Moscow

Alena S. Nikulina

I.M. Sechenov First Moscow State Medical University

Email: a.niku@mail.ru
ORCID iD: 0000-0002-0736-8022
SPIN-code: 8652-3101

MD, Graduate Student

Russian Federation, Moscow

Baira Damdinova

I.M. Sechenov First Moscow State Medical University

Email: baira_d@mail.ru
ORCID iD: 0000-0002-4162-2928
SPIN-code: 5350-3443

MD, Graduate Student

Russian Federation, Moscow

Sagibat Shakhmanova

I.M. Sechenov First Moscow State Medical University

Author for correspondence.
Email: Sonya271195@yandex.ru
ORCID iD: 0000-0001-8665-4731
Russian Federation, Moscow

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2. Fig. 1. Patient L., 45 years old, diagnosis of lichen planus: on the mucous membrane of the cheeks on both sides (a, b) there are infiltrated papular rashes of white color, prone to fusion with the formation of a peculiar mesh.

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3. Fig. 2. The same patient: on the dorsal surface of the tongue there are weakly infiltrated whitish foci with clear boundaries and a whitish-pink scar about 2.5 cm long, covered with a slight fibrinous plaque, slightly painful on palpation; papillae around the scar are absent.

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4. Fig. 3. The same patient: in the area of the medial surface of the right ankle joint, there is a typical pinkish-bluish papule of a flat shape with clear boundaries, polygonal outlines, on the surface of which a Wickham grid can be found without subjective sensations.

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5. Fig. 4. The same patient, condition after treatment (a, b, c): marked regression of rashes on the oral mucosa.

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6. Fig. 5. The same patient, the condition after treatment: in the area of the right ankle joint, there is a flattening of the papule with an outcome in pigmentation.

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Copyright (c) 2022 Grabovskaya O.V., Kayumova L.N., Nikulina A.S., Damdinova B., Shakhmanova S.

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
 


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