artupton-admin joined.
artupton-admin	Hi, Dr. Rees and Dr. Burkhart
artupton-admin	Can you see me?
artupton-admin	/room open
artupton-admin	Can Dr. Rees machine see us?
artupton-admin	welcome
artupton-admin	Hello
artupton-admin	Hello
drburkhart	Joan, we are currently just checking the system. We will begin in about one hour. See you then. Log in about 10 till the hour.
drburkhart	Hi everyone, we are still getting the system ready and will start at 6:30 CT so you may remain on the site or come back at that time. See you then
louise	nothing on the doctors has shown on my screen
drburkhart	Louise, we are not having the session right now, but will start in 25 min.
artupton-admin	Hold your comments and questions until the Drs. invite questions at about half way through the hour -- thanks.
drburkhart	Welcome everyone and thanks for joining us. We will begin by asking our guest, Dr. Eisen questions that have been submitted by you for the first part of the session. Please hold your comments until the last part of the session. We will then open the discussion for your comments and questions on any
drburkhart	on anything related to lichen planus. If your question does not get answered, you can email us and we will follow up on your specific questions. The response has been good and we will get to as many questions as possible. The questions have been grouped by subject matter.
drburkhart	Hello Dr. Eisen, we will begin by asking you a question that was submitted.
artupton-admin	Could you explain to us how vaginal lichen planus is diagnosed? What are some of the symptoms that may indicate that a women may have vaginal lichen? What percentage of women have both OLP and Vaginal LP? \
drore	It can often be diagnosed by the clinical signs present with /without skin and mouth findings. Other times, a biopsy may be needed
drore	Most frequent symptoms are burning, pain and itching. The most frequent signs at presentation are erosions and white reticulations
drore	About 50% of women that have vaginal LP will have oral disease
drburkhart	Dr. Eisen, Would a GYN be able to diagnose this easily?
drore	More and more articles have appeared in recent years in the GYN journals. Therefore, they are becoming more familiar with this disease. Often, the clinical featres alone will allow the GYN to diagnose this condition
artupton-admin	Do Hormones or the decrease in hormones, cause either OLP or Vaginal LP?
drore	No.the cause is unknown although a autoimmune theory has been suggested - the antibodies attack normal tissue causing damage. Hormonal changes do not cause the disease
artupton-admin	How often should a women be examined for vaginal LP or is this only if she has symptoms?
drore	If a patient has symptoms, she needs to be examined. Also, all patients with oral lichen planus and even skin lichen planus should be examined
drburkhart	For those of you just joining us, we will allow follow up questions during the second part of the session
artupton-admin	What is the difference between lichen planus and lichen schlerosis?
drore	Lichen sclerosis usually occurs on the vulva in women, sometimes on the head of the penis in men and on other parts of the body. The pesence of mucosal disease distinguishes lichen planus from lichen sclerosus, in which vaginal involvement almost never occurs. Also, unlike women with vulval lichen s
artupton-admin	Can you prevent or cure vaginal lichen in the early stages? Can a cream be used to help delay or improve the condition of vaginal LP?
drore	LP cannot be cured but their are many treatments and the response to treatment is usually good.
drore	Typically, topical corticosteroids are the mainstay of therapy. But there are other topical agents available and a number of internal medications can be used to slow the disease
artupton-admin	Should all women be checked for vaginal lp? When should they be biopsied? Can you tell if you have vaginal lichen without a biopsy?
drore	A doctor can usually tell if a patient has LP without a biopsy, especially if there are skin lesions or mouth lesions present. If they are not, then a biopsy may be needed
artupton-admin	Once you have scar tissue or closing of the vaginal area, can it ever be reversed?
drore	Scar tissue can be treated by using dilators and/or surgery. Surgical correction of introital stenosis and division of vulval/vaginal adhesions can be performed if needed
artupton-admin	Are you seeing an increase in vaginal lichen or just more effective diagnosis?
drore	We are seeing more and more patients diagnosed with this disease as more doctors become familiar with it. It is a relatively common disease, as common as psoriasis which affects 1% of the population
artupton-admin	How many men have genital lesions? And, do they also have oral lesions usually?
drore	Fortunately, men typically get LP infrequently on the penis. In patients with oral disease, fewer than 5% of men get genital disease vs. 25% of women who get it in the vagina and vuvla
artupton-admin	Is LP in the eosophageal area common? Is it just underdiagnosed?
drore	It is probably more common than diagnosed. We always ask patients with LP if they have any symptoms while eating or swallowing and if they do, we have then see a GI doc to check the esophagus
artupton-admin	Is there anything that can be done if you have LP starting on the scalp?
drore	Scalp LP is difficult to diagnose and requires biopsy. Once diagnosed we use topical and systemic therapy almost always as this disease causes scarring and loss of hair.
artupton-admin	What is the treatment for lp of the nails?
drburkhart	Everyone, we will give you a chance to ask other questions as well in the next portion of the session.
drore	We sometimes use potent steroid creams with occlusion, steroid shots into the nail bed area and for severe cases, immunosuppressive treatment
artupton-admin	Can Premarin cause vaginal or oral lichen?
drore	No steroids do not cause the disease
artupton-admin	Is lichen planus, either cutaneous, vaginal or oral familial?
drore	All forms of LP are not familial but a few studies suggest that it may be found sometimes in more than one family member
artupton-admin	Is there a connection with any of the following? Shingles M.S. Neurological Conditions Low thyroid Allergies and arthritis Varicose veins or "weak skin"
drburkhart	We are ready to answer any follow up questions or interests that you all have and try to get to as many as possible.
drore	Patients with one autoimmune disease such as LP may be more likely to get others such as thyroid disease, arthritis etc but LP is not specifically associated with any of the listed diseases
wren	Can Drore be specific re oral treatment?
coni	What are the symptons of esophagus LP?
sue	Dr
dbirdd	Dr. Eisen-what medication do you recommend for vaginal lp and do you use Protopic? Can you have lp inside of the vagina?
sue	Dr Eisen. Can we do anything to prevent vaginal lp?
bernie	what causes this disease?
kay	can OLP be sprfead via kissing?
heart	What medication do you recommend for lesions in your mouth?
duchess	Is Protopic safe?
handelman	What is your experience with TNF-alpha inhibitors in vulvar involvement? How quickly do pts respond? How long do you keep pts with only episodic flares on it?
judy	Is oral cancer more likely to be found with those having oral lp
dab	What is the treatment for eosophageal LP
kay	IS vaginal contagious??
handelman	Is candida infection a trigger?
drore	Treatment for oral disease include topical steroids, protopic, elidel and a number of internal meds: plaquenil, CellCept, Imuran and a number of others depending on the severity
coni	What does nail LP look like and are there symptoms?
carole_S	can estrogen ( vagifem ) be of any help and at what dosage
leslie	can VLP be mistaken for estrogen related atrophy?
drburkhart	Kay, lichen planus cannot be spread, is not contagious. You did not get it from anyone nor can you give it anyone.
drrees	bernie- sometimes it is possible to find something such as a drug allergy that is causing an LP like lesion but the cause is still essentially unknown
handelman	Have you used Enbrel successfully?
Sara	is it possible to have lichen planus on the head and not suffer any visible hair loss ?
esme	Ihave vaginal oral and Tear duct LP..can the tear duct be cleared by medication. Accupuncture has helped smooth the tissue in the oral and vaginal area
drore	Dr. Handelman: we have only recently started using TNF alpha inhibitors including Humira and Enbrel for LP. Some patients have had excellent results but not universally. Improvement is noted after about 6 -8 weeks and after 4 months, we taper the frequency of administering the drug, if possible.
drore	Insurance companies will generally require a letter of medical necessity demonstrating failure of other meds. We always use topical in conjunction to control disease and symptoms including pain.
atheso	Any diet I can follow for OLP? Things to avoid
drore	LP of the head may cause few signs and syypmtoms but if allowed to progress, will result in itching and hair loss
judy	How do you tell the difference between oral cance and OLP
mmclean	is clobetasol propionate a treatment for lp of the lip? is that a steroid ? antibiotic?
handelman	When will you publish a case serices on TNF-alpha inhibitors and other immunologics in LP?
heart	What can you use to help LP of the scalp?
drore	OLP is not contagious andcannot be transmitted
drrees	Heart- usually we start with topical corticosteroids at various strengths depending on the situation. If those don't work then intralesional steroids are possibly useful. Sometimes it is necessary to use various types of systemic meds to include prednisone
drore	Clobetasol is a potent steroid and should be used very carefully or not at all on the lip
rio	Dr.-LP has spread to my lower lip very tender, what can be done
Sara	How do you prevent Lp of the head from progressing?
handelman	Can gingival involvement also cause gingival recession?
JIM	How often should a biopsy be done
drburkhart	Judy, it is always wise to bring any changes that have taken place to the attention of your healthcare provider. Clinically, it is often difficult to tell the difference in ulcerative forms especially on the tonue.
drore	We used Enbrel with mixed results
dbirdd	Is lichen planus found deep inside the vagina?
mmclean	what is the best treatment (that I can use daily) for lp of the lower lip?
drore	Gingival involvement is a frequent cause of recession and requires more aggressive therapy - often topical and systemic treatment
handelman	What is you immunosuppressive of choice if oral prednisone, cyclosporine and all topicals have failed?
drrees	Judy- Oftentimes OLP and oral cancer will appear differently clinically but the most reliable way to tell is by biopsy. The problem is in deciding when and where to biopsy when someone has had lichen planus for several years plus how often to biopsy
blfisher	Will you please advise us about the risk of oral cancer with LP?
coni	Again, what are the symptoms of esophagus LP?
atheso	I am using Clobetasol. What do you mean by using it carefully? My doctor gave no specific instructions.
drore	Yes LP can be found deep inside and outside of the vagina
trisha	What evidence is there of heavy metals attributing to lichen planus ie from fillings ect.?
drburkhart	Dr. Eisen, what is the best way for a patient to find someone who is knowledgeable about the treatment of vaginal LP?
heart	Are there not natural products that can be used to reduce the spots? I have had great success with accupuncture, have you heard of this as a treatment?
duchess	Do you recommend Protopic?
ev	I have used acupuncture and herbs for OLP as treatment with great success
Sara	How common is it that Lp will burn out?
drore	LP of the mouth requires evaluation to make sure mouth cancer does not develop. There is a slight increased risk and therefore, we check patients regularly for this
bernie	Will oral LP spread to other parts of the body
drrees	mm clean- clobetasol is probably a good choice for OLP inside the lip but it is a bit too potent for the vermillion border
carole_S	how do you find a doctor who knows about VLP-GYn or dermatologist?
mmclean	mine is outside the lip -lower left region. what is a good daily treatment?
duchess	What herbs work for treatment"
ev	Have there been any studies relating LP to stress and loss
drore	I have had patients who have used accupuncture with some good results and others who found it to be not worthwhile
trisha	Once diagnosed, I began having lesions on my extremities and stomach. they seem to take about 6 months to heal. Can milk thistle help with skin lesions or is topical steriods the only option?
drrees	mmclean- ask your doctor about a mild topical steroid
drburkhart	Heart, I do get emails from patients who have found natural products that have helped them. The best way to try some of the products and techniques is find an person who practices in intergrative medicine. Don't just try everything that you hear or read about.
drore	LP will no spread to other boy parts by contact - it sometimes can just develop at different sites for no reason
mmclean	any studies using laser to remove the effected area altogether?
atheso	can you explain using clobetasol carefully?
atheso	How long can I be on Clobetasol
wren	Please comment on PProtopic
drore	Laser has been used in a few small studies but this is not a practical solution for an inflammatory process which can get worse with surgery such as laser
maggie	What treatment is available to stop the daily burning of the inside of the lip with oral lichen planus?
jchannell	drore , do you personally use laser surgery
dianefl	I have added Vit B complex which has seemed to help my immunity system and OLP improved
handelman	Which immunologics do you try first after prednisone, cyclosporine and topicals have failed? Plaquinil, CellCept, Enbrel, Humira?
jchannell	true, the site of my last biopsy 2 years ago still has not healed
drrees	handelman- we have studied that and don't find evidence that gingival OLP causes recession. However, difficulty in cleaning involved tissue and adjacent teeth can do so. Additionally there is some evidence that using potent topical steroids on the gums can thin the tissue and make it more prone to
drburkhart	Everyone, nothing takes the place of an excellent diet, stress reduction and excercise-these are basic. Find a good nutritionist as well.
judy	Is Fluocinonide topical cream a good ointment to use for OSP
ev	My acupuncturist gave me Huang Lian Shang Qing Wan from Bio Essence. It is a small pill made from rhubarb root that you allow to disolve. I have Lp esophogeally and orally. This helps a lot
drore	Protopic has been used in a number of studies but because it has a black box warning about a link to cancer and because LP may itself increase the risk of mouth cancer, the risks should be considered as well as its benefits
whitebirdy	I swish with salt water for my OLP and it helps a lot
drrees	Judy, fluocinonide is a good choice for many patients. However, we think the gel stays in place in the mouth better than the cream or ointment
drore	CellCept as it is better tolerated and fewer adverse effects than cyclosporine and imuran. Then we select Enbrel or Humire if they fail therapy
drburkhart	Everyone, we like to hear what you are doing and what works for you. Always email us with any comments that you have on the subject.
dianefl	I added Vit B complex to a daily Multi vitimin. I use Clobesterol upon flareups.
maggie	Can we ask permission from the memebers online to share their e-mail addresses so we may contact each other to be able to communicate more frequently?
spino	I have been on Raptiva for 8 mos. and it has helped me almost 100%
handelman	Philip Sugarmann's studies suggest TNF alpha involvement. Does that point to targeting these first?
drore	Burning in the lip can be alleviated with mild topical steroids
mmclean	any info about surgically removing the area?
leslie	My periodontist had me mix the steroid crem with Kanka - for cankor sores - helps the cream stay on longer
atheso	Can you explain how to use Clobesterol and how long can I be on it
dianefl	is Mucous Membrane Pemphigoid the same disease
drore	Dr. Handelman, maybe but it is difficult to know
drburkhart	Everyone be sure to check out our site. We have a page on how to apply medications and we also have one for dental check ups.
esme	I have gone on to a gluten free diet and there has been improvement along with accupuncture
judy	I am so concerned about oral cancer developing. Does a dermatologist or a dentist keep a check on this? And how?
carole_S	what about magic mouth wash?
drrees	leslie, good idea, even denture adhesive can be used to mix with the steroid and keep it in place longer.
trisha	Any adivise for skin lesions? Will the same things in the mouth work on the skin?
drburkhart	If you wish to share your emails, stay on line after the session and you can leave an address.
atheso	Any specific foods to avoid for OLP
drrees	dianefl- mucous membrane pemphigoid is a totally different disease with classic autoimmune features. However, the treatment may be similar
drore	Dentists and most qualified to examine the mouth for oral cancer. Questionable areas require biopsy. Other than that, a good oral exmination is needed periodically
handelman	Do you see lesions on the palate?
trisha	what about metals in the mouth such as many filling caps ect. should these be removed? Is there any evidence that metals can cause lichen planus
vina	I have vulvar lp, oral lp, hair loss on scalp from lp. I use dexamethasone rinse and seems to help my mouth. I was wondering if it can also be in the rectal area and cause bleeding. I think its a great idea for everyone to exchange e-mail addresses.
whitebirdy	My doctor asked me to avoid any food with citrus and alcohol for my OLP
ev	Athese, i need to avoid tomato, potato,avocado, spicy foods
drore	The skin lesions usually respond to topical agents and sometimes require internal medications - the same ones used for the mouth
drburkhart	atheso, from the responses that we get, anything that burns should be avoided, be sure to use dental products that are rather bland. Generally most patients do well with the Biotene products.
drrees	handelman- sure but palatal lesions are not a common as cheek, gingiva lips and tongue
mmclean	any docs in Jax, Fla that are knowledgable?
drore	Citrus, spicy foods, alcohol, tobacco in all forms, stress, trauma - all can make oral LP worse.
ev	Dr. Drore, I fear these medications. I don't want the cure to be worse than the disease
drburkhart	mmclean, email me and I will find someone for you.
atheso	How long can I be on Clobestrol
handelman	Has there been any efforts to educate Gynceologists about this disease?
sue	Add scratchy foods, such as chips, that can tear into the lesions.
drore	Ev - depending on the severity, certain potent medications may be needed and careul monitoring is required by docs who are familiar with these drugs
dab	what is the treatment for eosophageal LP??
judy	What a marvelous opportunity you are providing. Thank you.
coni	what are the symptoms of esophagus LP?
handelman	What should esophogeal biopsies be sent for to evaluate for LP?
drore	I have given many talks to GYNs and again, more articles are appearing in their journals- but they have much to learn
drrees	trisha- contact allergic reactions to filling materials both metalic and non-metallic can sometimes cause a lichenoid reaction but you certainly should not have fillings removed until you learn whether or not you are allergic to them
Ginger	Is there a medical advantage to having surgery to correct vaginal closure for someone with LP?
drore	Esophageal biopsies are taken when there are symptoms and visible lesions - usually in patients who have mouth lesions. Most esophageal lesions are white and sometimes eroded
coni	what are the symptoms of esophageal LP?
drore	Surgery for vaginal LP should be a last resort as any surgical procedure can make things worse - n the vagina or the mouth
ev	Is pain in the ear radiating from the esophagus?
drburkhart	To everyone, we have been taken aback by the numbers of emails sent by all of you regarding vaginal lp. Many women have not found a diagnosis for many years with needless suffering. Be sure to let you doctors know about the oral or cutaneous LP.
drore	Esophageal LP most commonly cuases pain with swallowing
loraine	what is an eroded lesion? what are the symptons of esophageal l-p?
handelman	Does gastric LP occur. On GI biopsies, do you request immunologic staining from Path?
Ginger	How can vaginal closure due to LP be treated if not with surgery?
drrees	atheso- some clinicians recommend that clobetasol be used continuously if needed ( I am in that group) Others think it is better to use if for a week or so and then take a week off then back on. There are no reports of serious adverse effects using it in the mouth.
heart	Is there any evidence that a biospy will compound or spread the oral LP?
drore	Vaginal closure - first with dilators and surgery if closure becomes severe
drrees	heart- I have never heard of this and not observed it in over 800 olp biopsies
just_me	Any useful over the counter product for OLP?
dab	For those not sure about clobetasol, I have been using it for approximately 6 years.
gm	When one is suffering from more than one type of lp, like oral and skin - what type of Dr should be consulted?
drburkhart	Heart, no a biopsy does not spread lichen. It is important to know exactly what you are dealing with.
dab	I should have added with no adverse affects.
atheso	Thanks dab. I just started clobetasol a week ago
drore	Gastric LP is exceedingly rare as is involvement of other body sites like the eyes etc. We just do not see it - even in my 2,500 patients that I treat with LP
ev	Biotene toothpaste and mouthwash is helpful to maintain hygiene. Tooth whiteners are killers and aggravate OLP
drore	Often, multiple docs may be needed - a dermatologist for the skin, a dentist for the mouth and a GYN for the vagina
dianefl	I had tried many ointments and found clobestrol to be the most effective. Also the Vit B comples really made a difference. I am 70 yrs. and had it since 64
coni	what does nail LP look like?
drburkhart	gm, the best way would be to find people knowledgeable in LP and then find a good GYN, Dermatologist and an oral medicine,pathology person
drrees	handleman- I am not aware of reported cases of gastric lp. We usually prefer to have immunofluorsecence on our biopsies but the expense probably dictates that conventional H&E evaluation is be used for classic cases and immunofluorescence reserved for cases that don't fid the classic pattern
ev	Does light therapy help
drore	Clobetasol is the most potent steroid and therefore has the potential for side effects causing yeast infections, atrophy and systemic effects if overused
bernie	Would teeth extraction help OLP?
gm	dr burkhart, we have been searching for someone knowledgeable in Denver for three years with no luck. How do we find someone?
atheso	Thanks dianefl to let us know that clobetosol is effective
handelman	Is Candida a known trigger for vulvar/vag LP?
loraine	Explain over use of Clobetasol. How often is over use?
atheso	what does atrophy mean
drore	Light therapy helps but light causes skin cancer and is also a potential problem as a treatment for a disease which already increases the risk of oral cancer
ev	Does that include LED therapy?
drore	The less the use of clobetasol, the btter. Once LP clears, use it as infrequently as possible - not to prevent. Better, a weaker steroid should be used once the disease improves
drrees	ev- I am curous as to why you asked that question. There are reports that describe using a light treatment called PUVA but it is very difficult to do in the mouth and there are potential adverse effects.
drburkhart	We also recommend one of the dental facilities available here in the U.S. and other countries who see a lot of patients with lichen such as here at Baylor, Harvard, Univ of Alabama, Boston Univ., Univ. of Pacific, Univ of Washington, Stoneybrook, Univ of Minn, Nova, and I could add more if I had ti
jchannell	how long can methatrexate be used
whitebirdy	which medicine is the best for OLP?
atheso	Thanks drore
atheso	Any suggestion for doctors or hospitals in cleveland,ohio
ev	Discovery channel had a show about children using chemo and the chemo caused mouth lesions. Light therapy helped
bernie	Thanks to all !
drore	Methotrexate can be used long term with good results but requires monitoring with blood tests and liver biopsy
drburkhart	to continue,: and I could add more if I had time. Just contact us and we will find someone in your area of the world.
dianefl	can increased use of NSAIDs be a cause?
maggie	I would like to share my e-mail address. mjbeyer@comcast.net I have severe oral lichen planus..
drrees	just me- you asked about over the counter products. There are no good studies that identify any as helping treat OLP but some such as alcohol free mouthrinses and bland toothpastes are very helpful in maintaining dental health.
drburkhart	Dr. Eisen, thank you so much. You have added so much to the discussion.
sue	My email is Helensue@yahoo.com.. I have erosive oral lichen planus
atheso	sowmya_venkatesh@hotmail.com. Severe Oral Lichen planus.
jchannell	jchannell email juanch51@yahoo.com
heart	Thank you very much, extremely helpful!
Carolyn	carloc2@charter.net
vina	My e-mail is cnvn20@aol.com
dbirdd	My email is jdtom@charter.net. I have both vaginal and oral lichen planus.
dab	I also would like to share e-mail as I have OLP, vaginal LP, and eosophageal. donnanharv@aol.com and burnsteel_donna@bah.com
ev	I have severe, now controlled with acupuncture OLP Email is evtessler@yahoo.com
jchannell	Thanks to Dt. eisen and rest of drs
drburkhart	Thank you everyone for all your questions. I will be happy to get any comments or emails from all of you.
sue	Thanks so much
drrees	Thank you very much Dr. Eisen. You have offered great info to a lot of people with significant questions. Also thanks to all participants for a most interesting session. i hope if has been helpful for you. Goodnight
Carolyn	thank you doctors!
dbirdd	Thanks for all the doctors for particpating and listening.
carole_S	I have long term OLP and now VLP Carole at momandmort@aol.com
loraine	Thank you all.
Ginger	My email is gingerkjones@gmail.com. I have oral and suspected vaginal LP
drore	Thanks you for having me.
atheso	Thanks for this great forum. Doctors like you make a difference in this world.
leslie	Thanks!! Leslie
vina	thank you all
spino	debi, would like to share my email address. I have severe LP. (30 yrs.) spino@bex.net
whitebirdy	My email is abbygomaa@hotmail.com I have Oral lichen planus and two lesions on my tongue
esme	I have vaginal oral eye LP using accuptuncture and gluten free diet cbmccaw@gmail.com
diann	Thank you Drs. I will be very interested in reading the full transcript when it is published. :-)
ev	Thank you doctors for making this forum possible
Carolyn	Please put LP in the subject line of your emails
drburkhart	If we did not answer your specific question, please send them to us and we will try to get a response to you. Send us suggestions.
just_me	oral OLP only - email is: goodhands000@yahoo.com
thecrew	I just logged on and missed the correct time, I will check transcripts tomorrow...Does anyone left logged on have an Erosive OLP diagnosis? I just got mine a month ago and am still living "in the dark"?
sue	yes
drburkhart	thanks everyone.
just_me	yes I too have erosive OLP
jchannell	have olp for 20 yers i feel your pain
maggie	thecrew check all the e-mail's addresses with the patients with oral lichen plaunus. You may contact them, as well as me, I too have oral lichen planus - hang in there - mjbeyer@comcast.net
	artupton-admin left.