Abstract
Lichen planus is a chronic inflammatory cutaneous and mucosal disease mostly affecting middle-aged individuals. The etiology of lichen planus is unknown, but current literature suggests that it is an altered immune response characterized by dysregulated T-cell activation and subsequent inflammation which can be associated with conditions like allergic contact dermatitis and hepatitis C. Additionally, heavy metals like lead, tin, arsenic, and bismuth can create inflammatory and allergic reactions that can predispose to the formation of lichen planus. This report examines the case of a 64-year-old female with longstanding oral lichenoid lesions with superimposed Wickham's striae, allergic skin reactions to several medications, and a history of receiving gold-containing dental implants. As a result of her history and subsequent allergy testing, she was found to have a gold allergy. The constant mucosal irritation from her dental implants likely was associated with the development of her oral lesions, which were confirmed to be oral lichen planus. She was recommended to apply triamcinolone 0.1% ointment to her oral lesions and to follow up with her dentist for evaluation of her filings. Further, it was recommended she replaces the dental crowns with compounds lacking gold to decrease the persistent irritation. This case represents the first such instance of gold dental fillings directly having an appreciable role in the development of oral lichen planus.
Highlights
Lichen planus is a disease of chronic inflammation but of unknown origin which typically occurs in the skin and mucosa of middle-aged individuals but can occur at any age [1]
The gold dental crowns caused a local allergic reaction in the oral mucosa, which further developed into lichen planus
The generalized Tcell dysfunction seen in contact dermatitis can predispose to the development of lichen planus, which is a delayed type of hypersensitivity
Summary
Lichen planus is a disease of chronic inflammation but of unknown origin which typically occurs in the skin and mucosa of middle-aged individuals but can occur at any age [1]. Erythematous papule (white arrow) denotes positive test for gold sodium thiosulfate Her dental conditions required the placement of multiple metal crowns. Pictures were not taken of the mucosal lesions Her clinical presentation, as well as previous history of lichen planus, made her oral lesions likely to be a continuation of the same disease process. As well as previous history of lichen planus, made her oral lesions likely to be a continuation of the same disease process She was recommended to apply triamcinolone 0.1% ointment to. At her follow-up visit, dental analysis revealed a significant gold content within the metal bases of her crowns. Further dental follow-up to potentially replace the crowns with compounds lacking gold was recommended to the patient
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