口腔病理科 On-Line KMU Student Bulletin
原文題目(出處)： Oral lichen planus in children. International Journal of Clinical Pediatric Dentistry 2009;2:49-51
原文作者姓名： Usha Mohan Das, Beena JP
通訊作者學校： Department of Pedodontics and Preventive Dentistry, KR Road, VV Puram, Bengaluru Karnataka, India
報告者姓名(組別)： Intern C 組陳元培
報告日期： 99/10/08
內文：
1. Introduction
Lichen planus is a common chronic inflammatory disease of skin and mucous membranes.
It is seen most frequently in the middle aged and elderly population and has a female to male ratio of approximately 2:1.
The etiology of lichen planus remains uncertain but many factors have been implicated. Such factors include genetic predisposition, infective agents, systemic diseases, graft-vs.-host disease, drug reactions, and hypersensitivity to dental materials and vitamin deficiencies.
Lichen planus has been associated with several auto-immune diseases, including lupus erythematosus, pemphigus, Sjögren’s syndrome and autoimmune liver disease.
The pathogenesis of lichen planus is not completely under-stood but a T-lymphocyte infiltrate suggests cell-mediated immunological damage to the epithelium.
Up to six clinical appearances of oral lichen planus have been described,5 including reticular, atropic, plaque-like, popular, erosive and bullous types.
The characteristic sites involved are the buccal mucosa dorsum of the tongue and less frequently the gingival.
There is very little literature on oral lichen planus occurring in childhood.
2. Case Report
Personal data: a 12 y/o female
Chief complaint: burning sensation in her mouth on consuming food for the past 3 months and bilateral pigmentation on the inner part of her cheek.
Medical history: noncontributory.
Extra-oral examination: with no skin rashes.
Intra-oral examination: bilaterally bluish purple striations in the posterior buccal sulci extending onto the buccal mucosa. This was approximately 8 mm × 12 mm in size, flat and nontender on palpation.
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口腔病理科 On-Line KMU Student Bulletin
The dental state was excellent and there were no amalgam restorations. No other mucosal or skin surfaces showed lesional changes.
A provisional diagnosis of reticular lichen planus was made based on clinical examination.
Routine haematology, biochemistry and immunology screen were normal except, Haemoglobin which was 9 gm% (normal range 12-14%).
Histopathological reports confirmed the diagnosis of the lesion to be Lichen Planus.
Treatment: topical application of 0.05% Tretinoin cream and under weekly review for the first month. Based on the prognosis a decision will be made after a month, whether to start the patient on systemic steroid therapy.
3. Discussion
Childhood lichen planus has been documented as a complication of Hepatitis B vaccinations . The recombinant proteins of the HBV vaccine, specially the may trigger a cell-mediated auto-immune response targeted at keratinocytes giving rise to a lichenoid reaction.
It is also found in association with predisposing conditions such as graft-vs-host disease and chronic active hepatitis C.
Studies of children with mucocutaneous lichen planus have shown a very low incidence of oral involvement(Kumar et al).
Familial lichen planus has been reported as being uncommon. Childhood familial lichen planus
occur at an early age and with greater severity.
Childhood lichen planus is more common in the tropics14 and that children of Asian origin may be prone to the condition.(Ramsey and Hurley)
4. Conclusion
Although oral lichen planus is considered rare in childhood, the presence of often asymptomatic oral lesions should alert the clinician to such a
diagnosis.
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口腔病理科 On-Line KMU Student Bulletin
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題號 題目
1
關於 lichen planus 下列何者敘述錯誤?(A)
好發於中老年人(B)
男女比為 2:3(C)
好發於兒童(D)
口腔中的病灶常見的有 reticular 和 erosive 兩種型態 答案(C) 出處：Oral and Maxillofacial PATHOLOGY, third edition, P680題號 題目
2
關於 lichen planus 的病理切片特徵下列何者敘述錯誤?(A)
Rete ridges 變薄而平順(B)
可見 hyperkeratosis(C)
表板下有 band-like lymphocytes infiltration(D)
Spinous layer 的厚度變化較大答案(A) 出處：Oral and Maxillofacial PATHOLOGY, third edition, P683
