Case presentation

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Case presentation
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Patient a 22 years old soldier was referred
to the oral medician department of Mashhad dental
school
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Chief complaint

• Pain and mouth sore during meals
• Gingival discoloration
• Aphtae
• With 5 months duration. . . . . . . .

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history

• 2medical
• 1 dental visits during the past 5 months

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• First G.P
• Mouth wash chlorhexidin
• Tetracyclin
• Diphenhydramin
• Second G.P
• CBC
• ESR
• FBS
• U1A
• Trigliserid
• thyroid
• Dentist refer to dental school

Si TIBC ferritin
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• Patient and his family didnt have any systemical
  and infections diseases only he had 5 kg loose
  weight

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Oral lesion
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Lower lip

• linear or reticular pattern of keratosis (Wickham
  striae)

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Lower vestibul

• Reticular pattern of keratosis near the right
  mandibular canin

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Lower vestibul

• Reticular pattern of keratosis near the right
  mandibular canin

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Rigth buccal vestibul

• Papular pattern of keratosis near the first and
  secound lower molar and a maplike ulcer near the
  canin

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Left buccal vestibul

• A maplike pseudomembranous and aphthouslike ulcer

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Left buccal vestibul

• Reticular pattern of keratosis from first
  premolar to the secound molar

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palatal

• Papular pattern of keratosis near the left first
  and secound molars on palatal

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palatal

• Papular pattern of keratosis near the right first
  and secound molars on palatal

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Upper lip

• Reticular pattern of keratosis

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gingivae

• Desquamative gingivitis from right maxilary canin
  to secound premolar

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gingivae

• Desquamative gingivitis near the left maxilary
  canin and first premolar

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Clinical diagnosis
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Guess what?!!
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• Erosive and keratotic lichen planus

Lichh..en planuusss!!!!
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Lichen planus

• Oral lichen planus (OLP) is a
• chronic inflammatory disease
• bilateral white striations, papules, or plaques
• on the buccal mucosa, tongue, and gingivae.
• Erythema, erosions, and blisters may or may not
  be present

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causes

• autoimmune disease
• unknown

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Plaquelike oral lichen planus on the buccal
mucosa on the left side
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Ulcerative oral lichen planus on the dorsum of
the tongue
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Reticular oral lichen planus on the buccal mucosa
on the left side.
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Wickham striae
Fordyce granules
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Differential diagnosis
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Differential diagnosis

• Lichenoeid reaction
• Lupus erythematosus
• Overlaps syndrom

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treatment
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1. Biopsy
2. Tab dexamethasone
3. Drop nystatin

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Takns for attention