Log file 120798.html for
Chat room Dental_Study_Club

-- Log on 120798.html started at Mon Dec 07 13:42:32 PST 1998

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Burkhart Welcome to the discussion group. We are here this afternoon with Dr. John Wright who is an oral pathologist here at Baylor. He is here to help answer questions for our group.Type HERE
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Burkhart Hello everyone, what questions or comments do you have?
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Virginia Hello. I was diagnosed with cutaneous lp over a year ago. It went into remission and then I now have oral and cutaneous. My dermatologist is trying trental in addition to topicals.
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Virginia Does anyone have any information or experience with this?
Burkhart If any of you are in the Dallas/Ft. Worth area and would like to participate in a new intervention group for lichen planus, please let us know.
Dick Type HEREIs there such a thing as lichen planus of the GI tract?
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Burkhart Virginia, we have heard of this treatment, and have a dermatologist here at Baylor that consults in our stomotology center.
kurgan has anyone tried topical cyclosporine to treat lp
Rochelle Few weeks ago had flushot and my LP flared-up,,,any relation?
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Burkhart Kurgan, yes that has been used, but is not the treatment of choice here at the center. The therapy is usually dependant on the factors that the particular patient exhibits.
wright Dick I'lm not aware of LP perse to affect intestinal mucosa. Its mainly skin, mouth,vaginal mucosa. There are some GI problems which predispose to lp like hepatitis but the disease itself doesn't tend to affect GI tract
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kurgan i'm also curious whether or not LP is related to the immune system
Virginia After my first LP diagnosis, I was also diagnosed with breast cancer. Is there a relationship here ?
kurgan is topical cyclosporin painful to the patient?
Rochelle With my LP condition, I have recently have had LUPUS label attached to me...what common thread LP & Lupus?
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wright Virginia No relation of lp to breast cancer
Burkhart Kurgan, lichen planus is not cosidered an auto immune disease but rather a cell-mediated immune response
wright kurgan topical cyclosporin is usually not painful to apply but it's very expensive
aupton Guests, this is the SYSOP, art. There are only 2 doctors with us tonight, and they are addressing your questions as quickly as possible. Thank you for your patience
Burkhart Kurgan, I will say that stress and life-events that alter the immune system have an effect on the responses of the body to injury and disease.
kurgan i have read in the literature that some systemic immunosuppressants have been able to treat some instances of oral LP...can you verify this?
wright Rochelle No relation of lp and lupus but the two are commonly confused. You probably don't have both. How were you diagnosed?
Burkhart Kurgan, these are used in severe cases and obviously with caution when topicals do not work.
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Rochelle Blood teats and screenings diagnosed my lupus.......further comment?
kjw This is a bit of practical information. I have switched to Biotene toothpaste and dental rinse. They are better than standard in terms of comfort and, I think, effectiveness.
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Virginia I am getting very good results now from Retin-A. Is this found to be effective for others? Lidex didn't seem to have any effect for me.
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wright Kurgan Other immunosuppressants have been used for oral lp with some success, but the mainstay of treatment continues to be topical steroids.
Burkhart KJW, yes we recommend these to mucosal disease patients. They work well since many patients have sensitivity to the additives in regular toothpaste and rinses. We also do not recommend regular mouth rinses.
Rochelle Any magic formula for getting rid of the redness in gums?
Burkhart Virginia, how long have you used the Retin A and where is the lichen planus?
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wright Rochelle How was your lp diagnosed? If you really have lupus, then it's possible that your lp is really a manifestation of lupus
Burkhart Rochelle, what are you currently using?
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Virginia I have been using the Retin A orally. I started with a .1% solution 3-4 times a day and it was irritating the corners of my mouth. I have been using it about 3 weeks. Have just switched to a .05. I tried it on my skin and it was too irritating.
Burkhart Do any of you find that there are certain foods that irritate your condition?
Virginia I haven't seen any connection to foods I eat.
kjw Foods that irritate are those I like best: citrus, spice (Indian and Mexican food), etc.
Rochelle Am currently using Temovate/OraBase.......& Dexamethasone elixir...but this rinse burns when used full strength!
Dick Type HEREWhat is the incidence of lp in the adult population and is it ever seen in children?
kurgan is retin A solution available or do i need to get a physician to experiment it?
Rochelle Also, have been on cortisone varied times......
wright Rochelle Treatment is aimed primarily at symptomatic relief but the redness should improve with many of the medications available to treat lp. It can sometimes take several months for improvement especially with topical treatment.
Virginia My dexamethasone is in a cherry-flavored elixir -- no burning at all.
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Burkhart The incidence in adults is about 2% but this figure is probably not accurate since there is some misdiagnosis and sometimes lp is not reported. We hope to get some good demographics with our survey which should appear soon. It is seen in children, but it is rare. I just talked with an oral pathologist who diagnosed lp in a 12 year old.
Rochelle Have had Oral LP since April 1991, and still there....
wright Rochelle Your meds should work. How long have you been using that regimen?
Dick Thanks for providing this fine service!!! Need to sign off
aupton Thanks for joining us, Dick. Keep in touch.
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wright Kurgan Retin A available by prescription only
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kurgan what other topical steroids are available that show clinical efficacy?
Burkhart Do any of you find that you are able to stop a full eruption by not eating certain foods or by some techniques that you have developed to cope with the lichen planus
Virginia My insurance will not cover Retinn A because it is not an FDA-approved use.
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Rochelle Was for short time on Zocor which brought about severe oral & vaginal LP........was taken off.
Burkhart Virginia, that we have not heard. Usually any medication that is recommended us usually covered for lichen.
aupton Is anyone other than kurgan and virginia waiting for a question to be answered?
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kurgan rochelle, what's zocor?
Virginia I think that both of my flair-ups could be directly related to an upsetting life event. I'm not sure how to avoide them!
wright Kurgan There are too many steroids to review all of them. Fluocinnonide is one of the best because there are few side effects with long term use. Diprolene and temovate work well also but less is known about safety using them orally and they much more commonly promote yeast growth as a side effect.
Burkhart Virginia, have you tried stress-management? Any relaxation techniques?
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Virginia Not yet, but that is something I have considered.
wright Rochelle What happened when you went off the Zocor?
kurgan are these topical steroid treatments reimbursable by health insurance plans?
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Rochelle Zocor.........for reducing Cholestoral
Burkhart Kurgan, yes usually.
Kathy Has anyone found an effective way of treating vaginal LP?
Virginia I am also on cholestoral reducing medications and blood pressure medications -- all of these seem to be on my dermatologist's list as trigger agents for LP.
Burkhart Virginia, I have spoken with hundreds of LP patients and reducing stress levels does have an effect on the disorder. Exercise and diet can have a profound effect on blood pressure /health.
Burkhart Virginia, yes, we see this all the time. Sometimes it is a matter of trial and error to see what the patients can tolerate and what works best.
kurgan doctors, what do you think of topical prednisone?
wright Kathy We don't have much personal experience with treating vaginal lp but the literature suggests that it responds similarly to oral disease but combinations of meds often have to be used. It's very rare to have vaginal lp without oral lesions.
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linda Could there be any relationship between an allergy to metal and my amalgam fillings that would cause lp?
Burkhart Kurgan, when were you given topical ?
Rochelle Sorry, I was disconnected.......back again
kurgan actually, one of my friend's have been diagnosed with oral LP... it's her first time and i'm trying to get as much information about it for her.
Rochelle When I went off Zocor, my LP condition, both oral & vag. got dramtaically better, and has stayed that way until recent flu shot.
kurgan she was unable to come on chat today so she had a list of questions for me that she researched
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wright kurgan I've not prescribed topical prednisone, I wasn't aware it was available in a topical form.
Burkhart Linda, this has been reported in the literature. Some emails from patients have been positive with this finding. Usually this is considered a lichenoid reaction. Dr. Wright has a good short article on this subject on our page. There is usually some indication through biopsy that the lp is a lichenoid reaction rather than a standard lichen diagnosis.
Kathy Has anyone noticed that their LP flare ups tend to be seasonal? As in about March & about September.
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kurgan is there any chance that flare ups are related to hormonal changes?
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Virginia What about genetic predispositions? Generally you hear about stress, drug reactions, and foods. My mother (now deceased) had OLP. My sister has discoid lupis.
Rochelle Would lupus bring about all the oral & vag. symptoms I have and not LP alone?
Burkhart Kurgan, lichen tends to appear in an age group when there are hormonal changes. So yes, many people that I talk with believe that there is a factor here.
Burkhart Kathy, this would be an interesting question for our survey. Are you able to document any environmental factors that occur during these months?
Rochelle My lupus physician took me off estrogen replacement therapy & my LP is better
wright Virginia lp is very common so just by chance alone it is possible for several family members to be affected. However, we do rarely see family clustering which happens more frequently than chance alone. I believe in some instances genetic predisposition plays a role but this is not the rule.
kurgan what's the prevalence of someone being diagnosed with oral LP and then getting vaginal LP?
wright Rochelle I think either lp or lupus could produce both oral and vaginal symptoms
Rochelle Yes, certainly..................oral, then vag. LP!
Burkhart We have some really good articles on this subject. Yes, this occurs. Dr. Drore Eisen has written some good information on this subject. If you send an email to me, I will send you some literature.
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Kathy I can't document any environmental factors other than to say that my flare ups occur pretty regularly around the middle of March and around the middle of September. Early warmth this spring brought about my symtoms earlier than normal. Stress also causes my vaginal LP to flare. I struggle to get my symtoms into remission - which I am able to manage- but come spring or fall their back like clockwork.
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Burkhart Kathy, this is interesting. Do you have any known allergic reations to anything?
Kathy Not that I know of
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kurgan about how many times should a person visit a physician during a flare up? also, how long does a flare up usually last?
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wright Kathy Remember that we do not know precisely what causes lp. I have always believed that it does not necessarily need to be one thing. I think it's possible that what ever it is that's causing your lp could somehow be seasonal but that is not a commone complaint among my patients.
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Rochelle Out of curiosity, in dental school, how much time is spent on discussingLP?
Burkhart Kurgan, good question. The answer is: as many times as you need to feel comfortable. Any erosive lesion should be monitored and the ideal is to control the lesion and keep it in a non-erosive state. Periodic biopsy may be needed also. It is important to take intraoral photos and to document any changes.
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Burkhart Rochelle, my dissertation was on lichen planus and patient education so I am biased-not enough!
Kathy I will be away from my computer for about 20 minutes- I'll be back then.
Burkhart Kathy, stay in touch!
wright Rochelle Obviously not enough. LP is covered in a variety of ways in the curriculum and I believe our students certainly know about lp when they graduate. Problem is that because it's not all that common, they don't get a lot of personal experience in diagnosing or managing patients with it.
aupton We have less than 10 minutes to go, folks. It's been good. Let's start winding down. Thanks.
Kathy You bet. Nice to talk to someone who knows something about LP.
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Virginia This is a wonderful service. I feel I have so much to learn. Thank you for making this available.
Rochelle Waiting for answer.......how much does estrogen replacement therapy add to LP flareups or cause LP?
aupton Rochelle, it is coming...
kurgan i'm sure my friend is going to enjoy your answers...she's been dying to ask these questions.
aupton Virginia, thanks for your particiption
aupton Is anyone else waiting for an answer to a question which has already been sent to us? ...
kurgan one more on her list is, are there any experimental treatments for oral LP like a clinical trial that she could find more about or get involved in?
Burkhart Rochelle, we are asking this queston on our survey. Unfortunately, there is not much information on this exact question. Perhaps some of the researchers who read our pages will begin something on this.
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aupton Check the web site by tommorrow afternoon for the log of this evening's session. The website address is http://www.tambcd.edu/lichen/
Virginia Can anyone participate in the survey? Get the results?
Rochelle Thanks, Doctors.........you're teriffic........I'll be awaiting news.
Burkhart Kurgan, We are beginning an intervention study with locals here in Dallas. The study is designed to provide stress management and some other interventions. If she is close to us, tell her to give us a call.
Rochelle How EXACTLY is STRESS related to LP flareups?
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Burkhart Thank you all for your good questions. If you have any follow up questions, email me and I will be happy to get back to you.
aupton Time to log off folks. Thanks very much to all our participants. The doctors will be leaving now. Keep checking the website for future discussion sessions.
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Rochelle When will next chat be?
aupton We'll post the next chat on the website. The address is http://www.tambcd.edu/lichen/
Rochelle Thanx...........
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-- Log stopped at Mon Dec 07 15:09:23 PST 1998
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