Oral Lichen Nitidus Case Report |
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Oral Lichen Nitidus Case Report

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A report describes a case of a 64-year-old female, who complained of raised areas on the roof of her mouth for 5years. She gave a history of a single episode of severe discomfort from the site; else her mouth was largely asymptomatic. She got relief from mild irritations by using a sodium-lauryl sulfate (SLS) free toothpaste. No history of any trauma or injury to the palatal mucosa was present. The lesions did not respond to the topical and systemic antifungal treatment. She reported possible medical history of previous vulval lichen sclerosis. 

She was a nonsmoker, alcoholic (6 units/week), and had no history of recreational drug use. She refused to have any skin lesions, thus a comprehensive skin examination was not performed. 

Intra-oral examination showed depapillation of the dorsum of the tongue and multiple discrete papules at the hard and soft palate, not more than 2mm in diameter. Few papules were erythematous and extended towards the uvulae and pillars of fauces. Other soft tissues were healthy.

The initial biopsy report taken from the hard palate was non-specific showing– relatively heavy ductal/periductal chronic inflammation of the minor salivary gland ducts along with mild lobular hyperplasia and keratosis.

More incisional biopsies were taken from the two separate sites of the palatal mucosa which showed patchy chronic inflammation with lichenoid features and prominent minor salivary gland tissue.

Routine blood investigations were within the normal limits.

The appearance of the papules was very unusual, thus a clinical diagnosis could not be made, while the differential diagnoses of papillary hyperplasia of the palate, candidiasis, stomatitis nicotina were made, which all were unlikely.

Thus, a re-evaluation of the histopathological slides was conducted which revealed that despite the presence of a dense band of inflammatory cell infiltrate adjacent to the epithelium, the histopathological features were not those of oral lichen planus (OLP) and thus suspected lichen nitidus (LN). Since LN is frequented on the skin, a dermatopathologist was consulted who agreed with the diagnosis of LN. The histopathological features were typical of LN with small raised nodules, lichenoid inflammation and a “claw clutching ball” configuration. While the inflammatory changes were similar in OLP, the architectural features did not resemble OLP.

She wasn′t given any active treatment as the lesions were largely asymptomatic. She was reviewed at 6 months, which showed lesions to be unchanged. She was reassured and provided with an open appointment.

Source: Dobson ML, Brown A, Theaker ED, et al. Oral lichen nitidus case report. Clin Case Rep. 2021;9(3):1110-4. 

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