Juvenile Oral Lichen Planus: A Report of 2 Cases

Meghan Sullivan Walsh January 2, 2011

Literature Review - St. Joseph/LMC Pediatric Dentistry

Juvenile Oral Lichen Planus: A Report of 2 Cases

Resident: Meghan Sullivan Walsh

Program: Lutheran Medical Center- Providence

Article Title: Juvenile Oral Lichen Planus: A Report of 2 Cases

Authors: Victoria L. Woo, DDS; Akanksha Manchanda-Gera, BA; Derek S. Park, BA, MA; Angela J. Yoon, DDS, MPH, MA; David J. Zegarelli, DDS

Journal: Pediatric Dentistry

Volume (number), Year, Page #’s; 29, NO 6, November/December 2007, pages 525-529.

Major Topic: Juvenile Lichen Planus

Overview of Method of Research: Lichen Planus or LP is an inflammatory disease which can present itself in a variety of formats and sites. Cutaneous LP is characterized as purple pruritic, polygonal papules with reticular striations found mostly on the extremities and lower back. Oral LP is divided into 6 subgroups; Papular, Reticular, Plaque-like, Ulcerative (erosive), Erythematous (atrophic) and Bullous. The two most common oral forms are Ulcerative and Reticular. Both forms present as bilateral, symmetric lesions with periods of quiescence and exacerbation. Of note is that LP is often found simultaneously with Lupus erythematosus, pemphigus, Sjogren’s syndrome, 10 autoimmune liver disease, rheumatoid arthritis and dermatomyositis. The purpose of this article was to report two children with documented cases of Juvenile Oral Lichen Planus and provide a literature review of this disease.

Findings: Two children presented to the Division of Oral Pathology, Columbia University College of Dental Medicine for evaluation of oral lesions. The first case was a 9 year old Caucasian female with bilateral tongue lesions which caused her discomfort with certain foods and liquids. Her medical history was negative. The lesions presented as ulcers on her right and left lateral ventral tongue surfaces with an adherent, white reticular and papular pattern. The histopathology report revealed lichenoid mucositis consistent with lichen planus. The patient was placed on beclomethasone dipropionate inhaler and dexamethosone elixir and advised to return every 6 months for future evaluation. Unfortunately this patient never returned for follow-up visits.

The second case was an 11 year old Caucasian female with bilateral, asymptomatic mucosal tongue lesions. The patient had a negative medical history but interestingly had received 3 hepatitis B vaccinations at 1 month, 2 months, and 6 months of age. The intra-oral examination showed classic white, lacy striations on the right and left posterior buccal mucosa. A biopsy confirmed lichen planus. Since the patient was asymptomatic no future treatment was given at this time. Follow-up of this patient in one year showed similar intra-oral lesions.

Key Points: Summary: Criteria for juvenile oral Lichen Planus include:

1: Patient is less than 20 years old

2: Clinical evidence of oral lichen planus

3: Oral biopsy confirmation of lichen planus, lichenoid lesion, or lichenoid mucositis

4: A clinical description of “reticular” or “reticulate,” “straie, or “straited,” and/or “lacy” oral lesions.

5: No evidence of mucosal contact with dental restorations, no exposure to medications known to induce oral lichenoid reactions and no history of graph verse host disease.

The literature review showed Juvenile OLP occurred more frequently in males, ages 11-15 with no ethnic predilection. The buccal mucosa was the most commonly affected site and most patients were affected by the reticular OLP. Important factors in the development of Juvenile OLP include previous Hep B vaccinations, liver disease and a genetic predisposition. Erosive OLP is extremely rare in the young population. Treatment of these patients is close monitoring of those asymptomatic and topical steroids for the symptomatic patients.

Assessment of the Article: Very well written article regarding Juvenile Oral Lichen Planus. Very thorough discussion of the disease, characteristics and treatment. Was surprised to hear about Juvenile OLP relationship with the Hepatitis B vaccination.