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| CASE IN POINT - PEDIATRIC ORAL MEDICINE |
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| Year : 2016 | Volume
: 2
| Issue : 4 | Page : 211-213 |
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Oral mucosal lichen planus in childhood
IE Neena, Shagun Sinha, P Poornima, KB Roopa
Department of Pedodontics and Preventive Dentistry, College of Dental Sciences, Pavilion, Davangere, Karnataka, India
| Date of Web Publication | 22-Sep-2016 |
Correspondence Address:
I E Neena
Department of Pedodontics and Preventive Dentistry, College of Dental Sciences, Pavilion Road, Davangere - 577 004, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2349-0977.191048
Lichen planus is a relatively common mucocutaneous disorder in adults, but it is rarely reported in children. Much less data is available regarding lichen planus in children. This is a report with intraoral lesions of lichen planus. Lichen planus, although reportedly rare in childhood, should be considered in the diagnosis of hyperkeratotic or erosive lesions of oral mucosa in children. Keywords: Buccal mucosa, childhood, lichen planus
How to cite this article:
Neena I E, Sinha S, Poornima P, Roopa K B. Oral mucosal lichen planus in childhood. Astrocyte 2016;2:211-3 |
| Introduction | |  |
Lichen planus is a common chronic inflammatory disease of skin and mucous membranes. It affects about 0.5–1% of the world's population.[1] Higher incidence is seen in middle aged or elderly, with female predilection at a ratio of 3:2.[2] Approximately half of the patients with skin lesions have oral lesions, whereas approximately 25% present with oral lesions alone.[2],[3] Oral lichen planus is a disease of adulthood and children are rarely affected.[4] Although the etiology of the condition remains obscure, it appears to be complex and multifactorial. The various factors include genetic predisposition, infective agents, systemic diseases, graft vs. host disease, drug reactions, and hypersensitivity to dental materials and vitamin deficiencies.[5] It has been associated with several autoimmune diseases, including lupus erythematosus, pemphigus, Sjogren's syndrome and autoimmune liver disease.
The pathogenesis of lichen planus is not completely understood, however, there is evidence suggesting an involvement of T cells.[6] Modified Langerhans' cells and keratinocytes possibly trigger an immune response and the recruitment of T lymphocytes, encouraged by expression of cell-surface adhesion molecules.[5],[7] Even though both, CD4 (helper) and CD8 (cytotoxic), cells are present, increasing numbers and activation of the CD8 cells is believed to cause the characteristic damage to the basal epithelium.[5],[8]
Up to six clinical appearances of oral lichen planus have been described, including reticular, atrophic, plaque-like, papular, erosive, and bullous types. Oral lichen planus may present anywhere in the oral cavity. However, the buccal mucosa, tongue, and gingiva are the most common affected sites. There is very little literature on oral lichen planus occurring in childhood. This paper reports a case of oral lichen planus in a child.
| Case Report | | |
A 9-year-old Indian boy reported to the Department of Pedodontics and Preventive Dentistry with the chief complaint of itching and burning sensation in the posterior region of the mouth bilaterally. During history taking, the patient revealed that the problem aggravated on consuming spicy food. There was no relevant medical, dental, and family history. The patient also did not report any deleterious oral habits.
Oral examination revealed a series of fine, radiant, white striae surrounded by a discrete erythematous border. The striae were bilateral and symmetrical in form, located on the buccal mucosa [Figure 1] and [Figure 2]. After observing these characteristic features, a diagnosis of reticular oral lichen planus was made. Treatment consisted of a topical corticosteroid gel to be used when symptomatic. Periodic reviews showed an improvement in both symptoms and the severity of the lesion. Three months after the onset of therapy, the patient was asymptomatic. The patient is currently on periodic review.
| Discussion | | |
Lichen planus was first described by Eramus Wilson in 1869[2] as predominately a disease of the middle aged or elderly. However, there is limited literature available reporting its occurrence in children.[7] In children, it is often associated with predisposing conditions such as graft vs. host disease or chronic active hepatitis.[9] Studies of children with mucocutaneous lichen planus have revealed a very low incidence of oral involvement. Kumar et al.,[10] in a series of 25 children with cutaneous lesions, reported only a single patient with oral mucosal lesions. The incidence of oral lichen planus was stated as 2% by Cottoni et al.[9] and 3.9% by Milligan and Graham-Brown.[11] Data from India show a wide range from 1.16 to 11.2%, thereby supporting the findings of Ramsay and Hurley [12] that childhood lichen planus is more common in the tropics.
There is disagreement regarding the clinical features of childhood lichen planus. Some authorities suggest that these are the same as that seen in adults, whereas others, such as Little, suggested that lichen planus in children was often atypical, with approximately half of his cases showing a “linear” pattern. Milligan and Graham-Brown [11] supported this observation, with only one out of six children showing classical cutaneous lichen planus. However in India, where a larger series was studied, more than 50% of patients had classical lichen planus.[13],[14]
There are a variety of possible reasons for the apparent rarity of childhood lichen planus. It may in part be due to misdiagnosis or, as in the cases mentioned above, lichen planus may be superimposed on a background of poor oral hygiene and irregular dental attendance, the latter reducing the opportunity for diagnosis. Lack of symptoms may also be one of the reasons the patient or dentist fail to report/diagnose the presence of the condition.
If lichen planus is an autoimmune disease, then as with most other such diseases, it may be regarded as a feature of advancing years and associated reduction in immune regulation. Considering a possible viral etiology, it may be that the viruses which usually affect adults are more frequently associated with lichen planus than those which target children. For example, the Hepatitis C virus, which is associated with lichen planus in certain population groups [15] is seen only rarely in the pediatric population. It has also been suggested that poor sanitation in India supports the transfer of adult viruses to children which may explain the higher prevalence.[9]
It is unusual for children to use those drugs known to be associated with lichenoid reactions. However, there are reports of childhood lichenoid eruptions following the administration of hepatitis B vaccine.[16] However, even though the abovementioned factors may be contributory, they cannot alone be responsible for the low prevalence of lichen planus in children.
In summary, although lichen planus in children is rare and oral mucosal involvement is even rarer, they do exist, as shown in our report. Hence, this diagnosis should be considered in children presenting with white lesions of the oral mucosa.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflflicts of interest.
| References | | |
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| 16. | Rybojad M, Moraillon I, Laglenne S, Vignon-Pennamen MD, Bonvalet D, Prigent F, et al. Lichen planus in children: 12 cases. Ann Dermatol Venereol 1998;125:679-81. |
[Figure 1], [Figure 2]
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