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Lichen planus (LP) is a chronic disease of the skin and mucous membrane. Oral lichen planus (OLP), the mucosal counterpart of cutaneous lichen planus that presents with a variety of clinical features, about 25% present with oral lesions alone. Patients may develop white striations, white papules, white plaques, erythema, erosions, or blisters affecting predominantly the posterior buccal mucosa bilaterally. The clinical presentation of OLP ranges from mild painless white keratotic lesions to painful erosions and ulcerations. The diagnosis of OLP was based on history, clinical findings and histopathological features. There is no consensus on a single set of criteria for the diagnosis of OLP. Some investigators use only the clinical criteria, while others use both clinical and histopathologic criteria. Furthermore final diagnosis was confirmed by Immunohistochemical staining (IHC) with CD8 precursor cells. The possibility of this lesion to turn malignant justifies the importance of early definitive diagnosis and long term follow up for patients with such disease. (2306) Abdurahman Musbah Elmezwghi, et al. E.D.J. Vol. 63, No. 3 damage to basal keratinocytes in the oral mucosa that are recognized as being antigenically foreign or altered.(8) OLP is a T-cell mediated autoimmune disease in which the auto cytotoxic CD8+ T-cells trigger apoptosis of the basal cells of the oral epithelium.(9) T-cells and macrophages comprise the dense sub-epithelial mononuclear infiltrate in OLP, and also there is an accentuation of T-cells within the epithelium.(9) Recently, there is increased intentness toward the role of mast cells (MCs) in the pathogenesis of OLP.(10) OLP may occur isolated or in combination with involvement of cutaneous sites or other mucosal sites,(11) approximately one third of the patients who have oral lesions also have skin lesions.(12) However, some studies report that OLP, without cutaneous involvement occurs more commonly.(13) Intraoraly, buccal mucosa, tongue and gingiva are most commonly involved. (14) They are usually symmetrical and bilateral lesions or multiple lesions in the mouth,(15) while other areas like mucosa of the palate and floor of the mouth are rarely affected (16). Mucosal lesions are classified into six clinical forms, described by Andreason: Reticular, papular, plaque (white forms), the reticular form occurs more frequently and is characterized by white lacy streaks known as Wickham’s striae, which generally are surrounded by discrete erythematous borders.(17) Atrophic, erosive and bullous (red forms).(18) The most common subtype, is usually asymptomatic.(19) Furthermore, the erosive and atrophic forms cause discomfort and painful symptoms.(20) The papular form of OLP presents as small white pinpoint papules about 0.5 mm in site. It is rarely seen and being small, it is possible to overlook them during a routine oral examination.(21) the papular type usually coexists with another type.(22-19) The plaque form of oral lichen planus is characterized by plaque like lesions, most frequently on the dorsum of the tongue and gingiva, clinically resemble oral leukoplakia.(23) Plaque-type affections were seen with a significantly higher frequency among tobacco smokers at the onset of OLP.(24) Lichen planus can be diagnosed clinically in classic cases,(25) but biopsy is recommended to confirm the diagnosis and to exclude dysplasia and malignancy.(26) Classic histopathologic features include the presence of a lymphocytic infiltrate in the subepithelial region in band-like patterns, liquefactive degeneration of the basal layer, Civatte ́s bodies, variable degrees of focal ortho or parakeratosis and irregular acanthosis (27).Several studies report the malignant potential of OLP. However, this topic is still quite controversial.(28) The frequency of malignant transformation varies between 0 and 3.5%, erythematous and erosive lesions show the highest index.(29) Therefore every patient diagnosed with OLP should be regularly monitored since malignant transformation can occur in all forms of OLP.(30)

A rare unilateral widespread multiple forms of oral lichen planus: clinico-histopathologic evaluation and diagnostic considerations: A case Report