Log file Lichen Planus
Chat room Dental_Study_Club
-- Log for 05 Aug 1998 started at Wed Aug 05 15:48:13 PDT 1998
aupton Welcome Lichen Planus chat participants. The doctors will be here in just a few minutes. aupton is the sysop. burkhart is Dr. Nancy Burkhart. gage is Dr. Tommy Gage and plemons is Dr. Jackie Plemons all of Baylor College of Dentistry. Enjoy!
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burkhart Welcome! Tonight we are joined by Dr. Tommy W. Gage, Professor in The Department of Oral Surgery/Pharmacology and one of our regular faculty members in The Stomatology Department here at Baylor. Also joining us will be our regular faculty members Dr. Jackie Plemons and Dr. Nancy Burkhart.
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burkhart The internet page is receiving many inquiries throught the weeks and the number of international inquiries continues to increase. Many of you have asked for educational materials and answers to specific questions regarding oral lichen planus. We hope that your questions have been answered as fully as possible and as quickly as possible.
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burkhart bjr Welcome! Do you have a question?
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Python hello
burkhart Hello Python-How are you?
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Python fine, trying to find out some information about lichen planus,
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burkhart Python, how can we help you? Do you have oral lichen planus yourself?
Python anyone knowledgable on oral lichen planus?
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Python I possibley have oral lichen planus, i have oral leukoplakia, 2nd biopsy hasn't come back yet..
burkhart Python, yes we will try to answer your questions.
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Python its affecting my lips, causing them to be very dry, and red, and irritated.. ever hear of this?
aupton bjr are you having problems with your connection?
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burkhart Python, yes there are many reported cases of olp in the lip area. Do you notice that this appears at any particular time?
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Python does the olp in the lip area affect the lip ?
bjr Type HERE I am having a difficult time typing tonight with one hand
burkhart Python, yes what are your symptoms?
bjr Does someone k now of a toothpaste?
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burkhart bjr, did you have an accident?
bjr Yes
Python well i have lukoplakia build up in my mouth mixed with yeast, antifungals have helped a little but not much, I tested hiv-, so i know thats not it. my lips get very RED,DRY, and burn , irritated, w/o ointment, they would dry up and crack
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bjr I too have oral lichen planus.
aupton bjr you're welcome to just 'listen' -- a transcript will be posted sometime tommorrow
bjr Thanks
aupton Folks,
burkhart Python, what ointment are you using?
Python elcon ointment, nystatin w/ter ointment
aupton Folks, 'bw' is Dr. Bill Wathen who has joined us tonight.
Python what do u think burkhart
Python hello dr. bw
bw hi, Python. I'm a general pratitioner, just listening in to try and learn something
burkhart Python, what factors do you notice that may the condition worse? OLP and candida infections occur in about 25% of the patients
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Python not sure burkhart, its at its worst now, all the diflucan, and ointments haven't helped my lips any, at times the leukoplokia or yeast will scrape off, other times it won't, same spot, I'm on diflucan right now
Python bitting into my lip made it worse, trying to bit the leukoplakia off, make it worser
aupton Marcus, do you have a question for the doctors?
Python are u a doctor burkhart?
burkhart bjr- here at the clinic we recommend toothpaste without sodium lauryl sulfate
bjr Thanks
burkhart Python, how many biopsies have reported that you have oral lichen planus?
Marcus Is it true that cyclosporin rinse has had disappointing results?
gage We have had limited experience with cyclosporine in lichen planus. Nothing very promising.
Python none as of now, the first one come back just saying resulting from lip trauma, it was from my lip, after i quit bitting it, it cleared up in that area, the 2nd one was from inside my cheek, it won't be back until late friday or early mon morning. i got lichen planus in my finger nails, I'm just trying to figure it out now, my dermatalogist doesn't seem to sure either on my lips
gage Python trauma will certainly make things worse in lichen and no doubt leukoplakia. It can be another form of tissue injury.
burkhart Python, lichen planus of the nails is reported in the literature and the biopsy of your lip area should confirm whether you truly have oral lichen planus.
Marcus I am taking metoprolol, and I have read that beta-blockers are lichenoid reaction suspects. Any experience here?Can beta blockers cause OLP in your experience?
bw python, Dr. Burkhart is indeed a doctor!
burkhart Python, do you notice that your life-style or stress factors make the situation worse?
gage Marcus, a number of drugs can evoke lichenoid like reactions; probabably not the diseae lichen planus. Beta blockers like propranol and pindolol have been implicated.
Python is lichen planus fungal? i had some problems with my lips getting dry before, and few swashes of nystatin oral and it would be ok, now nothing fazes it, when i first noticed it, was the next morning after a night of heavy drinking, my lips starting gettin gpuffy, never noticed the leuokplokia and yeast before till went to doctor
Python i dunno about stress, not really stressed, but i worry about this all the time, it affect my lips, it looks awful. been like this for a month.. i think beer made it worser, i quit drinking since then
Python I am also a 2nd time accutane user, that might have some importance to this, ever since i come off it about a year ago, ever once and a while my lips would act up again, but nystatin oral would stop it, now its out of control with leukoplokia (possibbly lichen planus)
burkhart Python, no lichen planus is not fungal. But, there is reported fungal (candida) infections reported in at least 25% of the cases. When the immune function is lowered or there is an inflammatory process present, the condition may be worse.
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Python what do u mean by inflammatory process present
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burkhart Python, from what you are telling us, you appear to be causing some trauma to your lip area. This leaves the tissue raw and possibly ulcer-like.
Python i haven't caused in truma lately, but this was all going on before i started bitting at it. in those 25% with candidia, does antifungals clear the yeast up , leaving just lichen planus?
Python what is inflammatory process present? how would your immune function be lowered w/o HIV?
gage Why are you using accutane?
burkhart Python, even stress related factors lower the immune system. Research studies have shown that any stress related activities will alter the immune system. We all have stress and the way that we cope with the stress is an important factor.
Python I come off it about a year ago for acne.
Python what was u talking about inflammatory process before tho?
gage Ok. I understand the Accutane, but one of the side effects of accutane is mucocutaneous lesions expecially on the lip
Python what is mucocutaneous lesions?
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gage Mucotaneous lesions are any lesions that affect the skin or mucous membranes.
Python ok are tehy white? leukoplakia like? are these lessions treatable? my lips was very dry like this while on accutane, but then cleared up, then everonce and a while they would actup, but nystatin oral would solve it, now nothing affects it
gage They could look like leukoplakia but could also be ulcers.
burkhart Python, inflammatory process is the attempt by the body to counteract the trauma by responding through cell function.
Marcus burkhart: how do you differentiate idiopathic LP from a lichenoid tissue reaction?
Python how do u get rid of them? uclers on your lip? are they tratable?
gage They lesions should begin to disappear with discontining of the accutane. How much sun expose do you have?
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Python not much lately.. could they come back? if so, is it reversable?
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Python I may have oover dosed on accutane, I was taking 1 pill one day, and 2 pills the next day, I talked the doctor in to giving me 2 pills a day, seemd to work better, but my skin was very very dry..
gage The oral pathologist sometimes can differentiate between lichen planus and lichenoid reactions. Howerver, it the person stops taking the drug and the reaction abates or disappears it should be some evidence of a cause and effect.
plemons Python, do you know what kind of pathologist read your last biopsy? Sometimes specimens from mouth lesions are confusing to general pathologists - you may want to have an oral pathologist look at the slides. A dental school in your area would be a good contact.
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burkhart Marcus, LP is sometimes differentiated through biopsy, but in many cases it is impossible to assess. Oftentimes, stopping the medication which may cause the reaction (lichenoid) will be adequate. Usually lichenoid reactions are bilateral rather than unilateral.
gage I don't think the lesions would return unless you started the accutane again if they completly go away.
Python just a pathologist from a dermatology group? i'm seeing a dermatologist right now, is there a better doctor i could see? if nothing comes of this last biopsy, hes planning on sending me to duke or some universtery dermatologist group
plemons Python, where do you live?
Python well they didn't completly go away well the lessions did, but something kept makeing my lips dry ever once and a blue moon, and nystatin oral would fix it, but now, nothing wil
Python Eastern Tennessee (near knoxville, tn)
Python i didn't notice any lessions while on accutane , just dry lips , tho they may have been there
plemons Python, there is a dental school in the Chapel Hill area.
Python not sure on chapel hill area.. could any of this be related to say wisdom teeth?
gage no
Python last time i went to dentist, (first time in about 5 years) they said i had beggining states of gingivitis, but after cleaning them, they said it should clear up
plemons Python, the tissue around wisdom teeth can become inflamed but is not related to lichen planus. Good plaque control and regular cleanings have been shown to reduce the signs of lichen planus.
burkhart Python, the literature and research studies indicate that you should have professional cleanings.
Python I'm just worried about my lips now, I've read horror storeis of burning lip syndrome and burning mouth syndrome where there nothign can help
Python i'm sure its related to all this leukoplakia in my mouth, cuz it wasn't there before, the doctor says there normally isn't any side effect to leukoplokia , so hes unsure whats wrong with my lips, maybe psorasis in the lips? is that treatable? i think its related to the leukoplokia and yeast
burkhart Python, lp has nothing to do with burning mouth syndrome
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Python what is burning mouth syndrome?
Python all of this started at the same time, so i'm sure its linked together..
plemons Python, leukoplakia is just a word meaning a white lesion in the mouth that hasn't been diagnosed or there is no obvious causative agent. It will be nice to find out a definitive diagnosis - maybe the latest biopsy will help.
Python maybe it will ... back to mucotaneous lesions, are they're any reported cases w/o acctuane use? can they be removed ?
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Python the doctor said something aobut cortozone (spelling?) could treat it depending on what kind it is
burkhart Python, burning mouth syndrome may have several causes but the origin is really not known.
gage Lesions do occur, but as I have said before if they are due to accutane they will disappear when the drug is stopped.
Python i have somethin gnow affecting my lips and i am not on accutane.
Python ahve u heard of burning lip syndrome burkhart?
Python what are the symptons of buring mouth syndrome
plemons Python, topical steroids are the treatment of choice for intraoral lichen planus. Cortizone is one form, but others are more effective.
Python what are the others plemons?
burkhart Python, patients complain about burning on the inside of the lip, but usually not on the external areas.
Python mine is burning on exterior not interior
plemons Python, Lidex gel is a very useful medication. Others are diprolene, temovate and ulltravate. You should use one at least as strong as Lidex to get a beneficial effect.
Python not sure if burning is the word, it gets very dry and such, like it was burn to a crisp if i don't use ointment
burkhart Python, good!
Marcus Doctors: is there agreement that acidic foods should be avoided in OLP?
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plemons Marcus, acidic foods are generally discouraged because of a comfort issue. I don't think that acidic foods themselves are etiologic agents.
Python whats those medicines use to treat plemons?
burkhart Marcus, most patients avoid certain foods that irritate the area. Keeping a diary about the foods that cause you problems may be helpful. Also avoiding tarter control toothpaste and mouth products that are harsh.
plemons Python, the medications I listed are used to treat intraoral lichen planus.
Python hmmm, plemons on the yeast mixed with lichen planus? will it go away with antifungals? will it return if the lenchen is not removed?
gage Each patient has to establish the foods they can tolerate. The food diary is an excellent way to help the patinet learn about their comfort areas. No doubt some ot the oral hygiene products are irritating also.
plemons Python,, the medications used to treat lichen planus often cause a yeast infection. If you are prone to yeast infections in the mouth, we give you both the steroids for your lichen planus and an antifungal at the same time. Yeast infections may occur occasionally in patients on topical steroids.
Python is some of lichen planus scrapable?
Marcus burkhart: are topical steroids the drugs of choice if there are extra-oral lesions also?
Python at times (same spot in mouth now), I can take my finger and scrape off the white, and at other times I can't.. ever hear of that?
plemons Python, some lesions of lichen planus cause the tissues to peel away leaving red areas. As a treatment I would not recommend scraping on the tissues.
Python I tried 7 days of predizone and it didn't work
plemons Python, did your lesions improve or change at all?
Python gotta run, be back later!
Python lessions change
aupton About three minutes to go, folks. Please start wrapping it up. Thanks.
Marcus Doctors- are there any investigational drugs showing promise in OLP?
burkhart Marcus, yes they are used in some cases. There are reported medications that are being used also - article in Dermatology, published 1997 by Argila, et. al.
Python I'm on diflucan now, and it seems to loosen it up maybe, and then at times, there isn't as much in my cheeks, and other times it is, I can scrape some of it sometime, and at other times it won't come off.
Python lessions seem to change a little, specially the ones on sides of my tounge
Python some of it seems to disapear at times and then it is there another time
Python i dunno... i gotta run now, my g/f is paging me, but I'll stop back in later, thanks for all the help!
aupton Ok, folks. Sign off time. Thanks for stopping by, and we should be posting the next chat soon.
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Marcus ciao
gage I am not sure if there are any specific breakthroughs or new ideas about lichen therapy; however chloroquine and other antiinfammatory drugs have been used. You may already know that some have used griseofulvin systemically to treat lichen.
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Marcus Thank you for the information.
burkhart Thank you everyone-stay in touch
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-- Log stopped at Wed Aug 05 17:07:33 PDT 1998
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