The next component of this presentation
will deal with non-neoplastic
highlighted by lichen planus.
We will segue through
other inflammatory conditions
which are immune-mediated
and terminate with precancer and cancer,
highlighted by the initial erythroplasia,
a highly worrisome problem that leads to,
in most cases, squamous cancer
or severe precancerous changes.
So we will begin with discussing
lichen planus and its various forms.
This can be a serious chronic problem
involving the oral cavity alone
or can involve the skin and other sites,
including those of the areas of the scalp,
flexor surface of the forearms,
the pretibial region of the legs,
scalp involvement, nail involvement,
So this is not necessarily
an oral disease only by any means.
Several facts about lichen planus,
up to 1% of the population is affected.
And those numbers will vary depending upon
the literature sources you choose to quote.
As evidenced in my practice, most of my
lichen planus patients tend to be women,
half or more of cutaneous lichen planus
can accompany oral lichen planus in women.
Average age of onset of oral lichen planus
tends to be middle-aged years.
The duration of the problem
before attention is drawn to it
can vary from weeks to months
to years, in fact,
and there are variable clinical presentations
which we will demonstrate.
Depending upon your sources,
you will see reference to
how many cases are seen
with concomitant skin lichen planus,
and this varies from 20% to 34%,
some patients have only oral lesions,
some patients have only skin lesions,
but basically, be aware of the fact
that this is basically
a mucocutaneous disease,
not just an oral disease.
As noted earlier, lichen planus
can affect the esophagus,
the urinary bladder,
the nasal mucosa, the scalp,
the eyes, the stomach,
larynx, anus, and genitalia.
Perianal itching is a commonly noted form
of lichen planus which must be addressed.
In women, vaginitis of one sort or another
must be separated from
the genital form of lichen planus.
Importantly, the lichen planus cases
involving the attached gingiva
carries a differential diagnosis
as the common feature
in all of those gingival lesions
which we will go into in some detail.