| .............. Log on May2001 started at Wed May 23 14:43:20 PDT 2001 ........... | |
| aupton | Welcome to the Baylor College of Dentistry Live Online Discussion. The Topic is Lichen Planus. The doctors will be logging on shortly. Please hold all discussion until the doctors are logged on. |
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| .............. Log stopped at Wed May 23 14:54:48 PDT 2001 ........... | |
| .............. Log on May2001 started at Wed May 23 14:57:22 PDT 2001 ........... | |
| DrRees | This is a test from Dr. Rees' chair |
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| aupton | Vik welcome. The doctors will be available in about 5 minutes. Please hold your questions until then |
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| DrRees | Hi, Dr. Burkhart. Dr. Rees will be here shortly |
| DrRees | Welcome, DE |
| DE | Type HERE Thank you, I'm delighted to be here |
| drburkhart | Hello all and welcome to the discussion session. It is a pleasure to have Dr. Eisen as our guest tonight. |
| DrRees | Hi Nancy, How are things at Kinko's? I quess it's time to begin. Vic do you have a question to get the ball rolling? |
| drburkhart | Hello Terry-actually, I highly recommend it! Especially, when your computer has crashed. |
| Vik | Type HEREI need to know more about oral and vaginal lichen planus. A family member has been suffering a long time and is getting no help |
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| drburkhart | Hello Leial, welcome! do you have a question or comment? |
| DE | About 25% of female patients with oral LP have genital LP |
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| drburkhart | Hello Jamer, Welcome. Please ask any questions that you may have for us. |
| DrRees | DE I know this also occurs in males. Is there a reason why it is more common in females? |
| Vik | Please let me know some of your treatments for oral and vaginal LP |
| jamer | Only recently receiving the diagnoisis of lichen planus, I still info seeking. |
| DE | We really do not know but it is far less common on the penis that on the vagina |
| Leila | Type HEREHi! Yes - I have read the previous transcripts - one discussion nothed that in a biopsy you can tell whether the OLP is alichenoid reaction rather than a stansard lichen diagnosis -- Does this mean you can tell if its an allergic response?? |
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| drburkhart | Jamer, Were you biopsied? Where is the LP? |
| drburkhart | Hello Lin, Wel come! Do you have a question or comment for us? |
| DE | Treatments for LP, whether it is in the mouth or genital mucosa consists of potent topical steroids. If that does not work well, then there are other topical and systemic treatments |
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| DrRees | Leila- There are some histologic features that may suggest an allergic reaction but I don't think one can reliably tell if the reaction is lichenoid. |
| jamer | No, the doctor said it was classic lichen and if he were teaching a class he would use my mouth as model. After you recent referall, thank you, on June 19 I will be seeing a doctor in Memphis |
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| Lin | yes biopsied 1 mo ago - in mouth on cheeks & under tongue - gums too |
| Leila | I am interested in the question of OLP as an allergic response because 10 years ago I had a pretty severe case of adult pattern eczema that went away when I was successfully treated for a fungal infection in my toe. Any possibility that LP is a reaction to a mundane allergy, like dust? |
| Vik | A person using Temovate, Resstoril, Tylenol #4 (up to 20 a day) for several years - is this typical? |
| drburkhart | Dr.Eisen, Many women contact us wanting to know if there is a connection with HRT and vaginal lp. Would you comment? |
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| DrRees | Leila- Since we don't know what causes LP it is certainly possible but I don't think there is any data to support that concept now. |
| Lin | could it be alergy response to sensodyne toothpaste, or Prilosec or Betimol eye drops??? |
| DE | We have not found any connection with LP of the vagina with other disorders |
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| drburkhart | Jamer, I am happy that you are seeing someone in Memphis. |
| Leila | Any indication use of Nasonex or Flonaise will prompt it to appear? |
| drburkhart | Hello Toni, welcome! Do you have a comment or question for us? Do you have oral lichen planus? |
| DE | Lin, although it could possibly be due to allergies to any of the agents you listed, it is unlikely and difficult to prove unless you stop it and then the disease returns when you try it again |
| DrRees | Lin, an allergic reaction to toothpaste is always a possibility but Sensodyne is not high on the list known to cause the reaction. What flavor is it? |
| drburkhart | Hello Philip! Good to hear from you. |
| PhilipSugerman | Hi Nancy |
| drburkhart | Everyone, Dr. Sugerman has been a guest on a previous session (see transcripts at some point). |
| PhilipSugerman | I saw the invite for the session so I thought I'd drop in |
| Lin | Max strength wflouride/tartar control/whitening - flavor does not say smells minty |
| DE | Hi Philip glad you can join us (Drore Eisen) |
| drburkhart | Philip, please jump in with any comments or answers. |
| jamer | I have been taking Inderal for about 12 years and I read on a web site that it could possibly cause oral lp, any stats on that |
| DrRees | Leila, it is doubtful that either of those are causing the reaction. Are you taking any other medications? Why do you use the flonase? |
| toni | Type HEREyes and also on my wrists and feet from time to time |
| PhilipSugerman | Hi Drore, I missed the first couple of minutes - any unresolved issues? |
| DE | Jamer There are no stats but only a few case reports and they are poorly documented |
| Leila | I have bad dust allergy - flonaise or nasonex handle it great |
| DrRees | Lin- Why don't you try a real bland paste such as Biotene and see if it makes any difference. Many tarter control pastes have cinnamon flavoring in them and those can cause a problem for some people. |
| DE | Philip, we were discussing LP vs lichenoid eruptions |
| drburkhart | Dr. Sugerman, could you comment on any new research or findings in the area of LP (any type). |
| Lin | I have recently switched to Biotene tooth paste & mouth wash and after 4 day mouth is much improved in regard to comford and less discomfort and irratiation OLP same but inflamation on gums etc better |
| toni | how can I prevent oral lp from becoming malignant |
| DE | Toni, although there is no definite proof, by adequate treatment, the lesions should resolve which should prevent malignancy |
| Lin | does OLP run its course or is it a life long disease? |
| DrRees | Lin, It is a little too soon to know if that will help but it is important to remember that someone needs to be treating you to determine whether or not your OLP is improving. |
| drburkhart | Lin, we hear this weekly. Biotene toothpaste is usually tolerated by most patients. |
| DE | Lin, the disease is usually very chronic and lifelong for the majority of patients. Infrequently, it can go into long term remission |
| Vik | How many patients have you seen with LP that has lasted several years? Any leads on how to get a hold on it? |
| DrRees | Lin, on the skin LP seems to have a predictable course. In the mouth it may last for a few months or for many years. |
| Lin | oral surgeon told me to brush with plain water but the irratation never went away the biotene products seem soothing |
| Leila | How often should someone be checking the progress (or regress?!) of my OLP? |
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| Leila | I was diagnosed in September - haven't had it long and first bad flare up in March |
| Vik | [Vik] What pain medications have you seen that help both oral and vaginal LP? |
| PhilipSugerman | We have recently identified a role for mast cells in OLP. Mast cells are usually associated with allergic reactions such as some asthma cases and skin hives. We don't think OLP is related to these allergic conditions, although there is some mast cell activity in OLP lesions |
| DE | Leila, it depends upon the type of disease you have. If there is minimal inflammation and no open sores, then infrequently, maybe 1 time yearly. If there are open lesions and ulcers, much more often |
| DrRees | Leila, That depends on what type of OLP you have and how much discomfort you are having. Your dentist or physician can be the best judge. We like to see patients often until we have things under control. |
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| drburkhart | Toni, the important point in preventing malignancy is to be sure that the lesion is lichen planus. The confirmation is made through biopsy and that it is monitored periodically. At the stomatology center, patients are checked on a regular schedule. If any changes occur, the patient is encouraged to come in. |
| DE | Vik, we try to minimize pain meds but treat the disease more aggressively with systemic meds to control the inflammation and the pain |
| Lin | the doctor did not prescribe yet because said I should reserve treatment for most acute episodes and at the moment it is tolerable but I dont eat rough foods or anything that would irratate it more - I am very careful |
| Leila | I have spts in the back of my mouth, one on my tongue and now some gum involvement - I am getting a biopsy next month . Should I be asking the oral surgeon what type(s) I have, any other questions? |
| DrRees | Lin, You have probably already answered this but have you been diagnosed by biopsy? |
| Lin | several months ago before dx it was very bad and cheek very thickish not very elastic extremely painful where cheeks meet gums and under tongue |
| Vik | [Vik] But here I have someone taking up to 20 tylenol #4 a day plus using temovate and a mouth rinse. Shouldn't there be more for yer to do? |
| DE | Leila, you should also have a physician check to see if you have genital involvement |
| Lin | yes biopsy = oral lichen planus |
| Leila | I have done that -- when I saw my internist for my regular pelvic |
| toni | I have tried B complex for mouth pain and it seemed to help |
| DrRees | Vik- Yes but I think we need more details. You probably should contact us by e-mail and perhaps we will have some suggestions. |
| Vik | [Vik] the e-mail I should use is what? |
| Lin | I too went to my regular doctor for physical & pap and it came back abnormal I have appt with GYN for closer look do I need to say or mention anything about the OLP I have no vaginal discomfort |
| drburkhart | Dr. Eisen, How often do you see both oral and genital LP in a patient? Do women often have these two and the vaginal goes untreated-a connection is not made? |
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| DrRees | Lin, By all means let your GYN doc know that you have OLP. |
| DE | Unfortunately, many GYN docs do not recognize vaginal LP which is present in about 25% of women with OLP |
| DE | Dermatologists are more likely to identify the disease on the genitalia |
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| Vik | [Vik] What would help the GYN detect the disease? |
| DrRees | Vik- the e-mail address is listed on the web site. Contact us. |
| Lin | with vaginal LP are there symptoms or discomfort?? I don't seem to have any noticed symptoms |
| DE | About 50% of patient with vaginal LP have symtoms, the rest do not. These lesions look almost identical to those in the mouth |
| drburkhart | We are seeing that many women who complete our survey report findings that could represent genital LP, but the suggestion has never been made. Do you suggest that patients who are diagnosed in a dental office should be told that there is a possibility? |
| Lin | Is it important to treat the OLP or just treat mild discomfort or do you just treat when there are acute flare ups |
| PhilipSugerman | Drore, do you see vaginal lichenoid drug reactions? Are the same drugs involved as in OLP? |
| DrRees | Vik- although that is out of my area of expertise I think it looks like OLP and a biopsy would confirm the diagnosis. |
| Vik | [Vik] Lin, my sister has a great deal of pain. She cannot even put in the smallest tampon and a vaginal exam is more than she can bare |
| DE | I believe that all newly diagnosed women with OLP should be evaluated for the possibility of genital involvement |
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| Lin | Do I need to ask the GYN for any specific test?? |
| DrRees | Lin, everyone is different. Mild discomfort to you may be severe discomfort to someone else. I believe you should treat the mild lesions with mild topical steroids and on occasion they will disappear. |
| DE | Vik, your sister unfortunately has advanced disease which leads to scarring. Treatment at this point can be very difficult and often requires surgery |
| drburkhart | Hello LFinn, Welcome! Do you have a comment? Do you have LP? |
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| DE | Lin, no specific test, just a good clinical examination |
| Vik | [Vik] There is surgery? No one has mentioned this before. |
| LFinn | Type HEREThis is Leila -- I got booted and I couldn't log back in under Leila! |
| DE | Vik, Surgery to correct the strictures from scarring, not for the inflammation |
| DrRees | Vik- The surgery is for scarring which doesn't normally happen in the mouth. |
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| Vik | [Vik] Has photochemotherapy worked for anyone? |
| Lin | Good that was my next question re if scaring in mouth happens |
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| drburkhart | Philip, are you still seeing many lichen planus patients at the University of Queensland? Do I have that right? |
| DE | Vik, photochemotherapy is still highly investigational. Since OLP may transform into malignancy and phototherapy is known to induce skin cancers, much more research needs to be done in this field before we use it |
| DrRees | Vik- It has been described by case report but there is not much in the literature and there are potential side effects. In my view one saves things like that for last resort efforts. |
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| LFinn | My OLP had started to effect my gums -- how concerned should I be about my teeth? |
| toni | Is lp an autoimmume disorder or hasn't that been determined yet? |
| Lin | In reading the past chat I got impression OLP did not usually get cancerous - do I need routine check ups?? and which doc do I see - the oral surgeon - my primary care physician or my dentist. my dentist has been least helpful but now my reports have been sent to him so he will be aware |
| DrRees | LFinn. The main concern with the teeth seems to be that with sore gums you have more difficulty in maintaining good oral hygiene. That could lead to more cavities or gum disease. |
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| DE | Lin, if left untreated, your OLP may cause gingivitis and lead to a more advanced form of gum disease with tooth problems |
| LFinn | Since switching to the Biotene -- the stinging is gone so much more pleasant to brush! |
| PhilipSugerman | Nancy, I was seeing many OLP patients at The University of Queensland until Novemebr 2000. In a quick survey I undertook there, OLP was the most common reason for referral to the Oral Pathology Clinic. I am now doing further lichen planus research at AstraZeneca in Boston |
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| Lin | Has LFinn tried the Biotene products - i really had difficulty brushing well due to the major pain but now it is much more comfortable |
| LFinn | Yes! |
| DrRees | Lin, yes you need routine checks. The one who diagnosed the disease is probably the one you should see. As an alternative dermatologist deal with lichen planus all the time and certainly could be of help to you. |
| drburkhart | Dr. Eisen, would you comment on the age range of women with vaginal LP. Is there an age range for men? We are hearing of some very young people with associated problems. |
| jamer | I feel I have a long road ahead of me after what I've read tonight. Are there positives I can count on? |
| LFinn | What are the chances that getting OLP first you'll develop the skin type? |
| Lin | I get skin problem easy such as alergic reaction to bug bites and plants etc I am a very careful nature lover I have not had major skin problem for about 20 years and these last two I seem extra sensitive - will the LP get on my skin too |
| DrRees | Philip, we find the same thing in our stomatology center except that dry mouth is about to overtake OLP. |
| Vik | Do you feel there is any connection between old fillings and OLP? |
| DE | I have just submitted a manuscript that describes OLP in young adults and children. Fortunately, these are not common. With regard to age, most women develop the disease in the 50's and 60's but not uncommonly, in the 40-50 age group. Men seem to develop it younger |
| toni | I use triamcinolone acetonide dental paste USP 0.1% is this the current best treatment and can I use this while breast feeding? |
| LFinn | I am 39 |
| PhilipSugerman | Drore, do you see genital lichenoid drug reactions? Are the same drugs involved as in OLP? |
| drburkhart | Philip, I did not realize that you are in Boston. Are you seeing patients there? |
| PhilipSugerman | Nancy, I'm not seeing patients at present |
| LFinn | ANy treatment centers in Atlanta GA? |
| DE | Philip, of the 250 women with vaginal LP that I treat, only 1 was identified as having a drug reaction to a diuretic. It's rare |
| drburkhart | To all: we have been contacted by several people who ask about breast feeding and the use of corticosteroids. Any comments from anyone? |
| DrRees | Vic- Dental fillings are sometimes a problem. With old ones if there is a reaction it might be because the mouth is dry. Saliva washes the allergen away most of the time even if it is there. |
| DE | Jamer, there are lots of positives, namely, we have numerous medications to control the disease and lots of research is underway testing new products |
| Lin | for a year my dentist kept telling me i just had classic dry mouth but now that I have a dx I feel better just by getting information and knowing not to continue using regular toothpastes - dentist never mentioned the Biotene even when he said I had dry mouth but that has been my best thing i tried after reading you previous chats |
| Lin | I am 54 |
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| PhilipSugerman | Drore, that's very interesting and suggests that the oral mucosa is more susceptible (compared with other sites) to lichenoid drug reactions. I wonder why? |
| DrRees | LFinn, Check at Emory University Medical School. There are some experts in this field there. |
| DE | The use of corticosteroids during breast feeding or pregnancy should be limited to the least potent agent and the infrequent use, only for painful and limited applications |
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| Vik | Actually I mean't do old fillings ever increase the chances of OLP or contribute to the severity of it? |
| jamer | Is a dry mouth a symptom? only diagnosed 2 weeks ago, but have had a dry mouth for years. |
| DE | Philip, I am not entirely convinced that oral liichenoid eruptions are much more common than vaginal lichenoid eruptions. Either they are both rare or we may be overlooking them |
| drburkhart | Have any of you made any life-style changes that have helped to lessen the lp? |
| DrRees | Vik- That is what I meant too. Sometimes a patient can have fillings for years and then develop a reaction to them. Sometimes the reaction is OLP. |
| DE | I agree with Dr Rees, old fillings can certainly produce OLP like lesions adjacent to the fillings |
| Lin | I started with noticeable shedding of skin after brushing teeth that is why i suspected allergy to toothpaste but dentist said that was normal with dry mouth and allergy not likely |
| DrRees | Lin, Do you know why your mouth is dry? Are you taking medications that may be causing this? Shedding of skin is not a normal feature associated with dry mouth. |
| drburkhart | DE, this is an important point. Many women have trouble with yeast infections and many of the women who complete our survey report symptoms that could be yeast infections or a number of other items such as lp. Most of the time, they are continually treating themselves for yeast. |
| Lin | my most intense irratation is gum below dental work but thought it also might be because food also collects there and irratates |
| DrRees | Lin, You are probably right but that is certainly something your dentist can evaluate and discuss with you. |
| LFinn | I have seen warnings about mouth yeast infectons when using the topical corticosteroid (did I get that right ?) creams - maybe it's obvious but what does this look/feel like? |
| DE | LP in the mouth and vagina can be secondarily infected with yeast, especially with potent steroid use. I routinely look for this especially when patients develop flare ups unexpectedly |
| aupton | About ten minutes to go, folks |
| DE | LFinn, sometimes you feel nothing, other times it causes a great degree of pain, especially if it gies down the throat. Your dentist can usually recognize the signs |
| PhilipSugerman | Drore is there any suggestion of a role for viral infection, mechanical trauma or contact sensitivity in genital LP? |
| Lin | I currently am losing weight (with doctor care) and have recently quit taking Prilosec only med currently on is the Betimol eye drops (one drop 2x per day) my symptoms did start after I increase dosage from one drop per day to two but am not sure if there is a connection and do not know if I have any alternative medication i can use to find out have appt with eye doctor next month |
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| DrRees | LFinn, It may present with white patchy areas that rub off. At other times it may be red. There are ways to determine if yeast is a problem but usually we can tell by the appearance. |
| DE | Philip, mechanical trauma for sure. Women with active disease almost always will complain of flare ups with intercourse. |
| DrRees | Lin, on rare occasions LP can affect the eyes. If you are reacting to the drops i think it would be more likely to show up there than in the mouth. |
| drburkhart | Does anyone have any comments on green tea and the oral mucosa? I have seen some reports in the research journals that we are seeing positive results. Any comments? A few cups of tea could be beneficial? |
| Lin | the olp moves around sometimes different area painful from day to day - how is that?? |
| PhilipSugerman | Drore, do you think this is a Koebner-like effect |
| DE | I also wanted to stress tonight that if patients complain of pain with swallowing, a GI evaluation may be needed to exclude esophageal involvement |
| drburkhart | DE, do you see many patients with throat involved? We have had at least four patients contact us lately with questions. |
| DE | Philip, I strongly believe the mouth and genital tract koebnerize |
| LFinn | I'm off - Thanks so much for this forum! |
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| Lin | when all this started a year ago I also had very low blood count and underwent endoscopy and colonoscopy for possible blood loss but they did not find anything just a very scarred esophogus from acid reflux |
| DE | Nancy, we have had many patients with OLP that we sent for endoscopy and found that surprisingly, many of them has LP, proven by biopsy |
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| PhilipSugerman | Another excellent discussion - thanks Nancy et al |
| DrRees | Lin, your acid reflux could certainly be one of the reasons your mouth is sore. Is it under control now? |
| drburkhart | All: please contact us with any follow up questions or comments . The transcipts will be posted soon. This has been a most interesting session. |
| drburkhart | Thank you Philip. |
| Lin | could the scarring actually have been LP or would the doctor known |
| DE | Scarring in the esopagus from LP is well described but unless there was active disease, there is no way of knowing |
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| Lin | treated reflux for 3 year and has been under control since tx began - now am no currently taking Prilosec because I am trying to illiminate any drugs to see if reaction to OLP and have lost weight so no reflux at present |
| DrRees | Thanks to you Dr Eisen for your invaluable input. Philip, Now that you are in the US for a while hopefully you can join us more often. |
| drburkhart | Dr. Eisen, thank you so much for adding the new information about the importance of diagnosis in the genital aspects of lichen planus that is often overlooked. |
| aupton | Thanks to all. Time to sign off now. |
| aupton | Goodnight all. |
| Lin | THANK YOU ALL - THIS IS VERY HELPFUL |
| DE | Thanks and I would be happy to answer email questions |
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| drburkhart | Thanks everyone. We will see you next time! |
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