Oral lichen planus occurs on the tongue, palate, buccal mucosa and lips. Lesions on the mouth may precede skin lesions. The most common oral form of lichen planus is a white lacy eruption, but keratotic, vesicular, erosive, atrophic or bulbar lesions also occur. Symptoms include burning, irritation and sensitivity to hot food and liquids. Lesions may disappear spontaneously after several months, but leukoplakia and malignancy may develop.
Most lesions require treatment for symptomatic relief.
Topical or intralesional steroids are usually effective. Resistant lesions, especially the ulcerative form, may respond to treatment with retinoids, plaquenil or psoralen-ultraviolet light. Pleural effusion occurs when the filtration rate creating pleural fluid exceeds the reabsorbing capacity of the lymphatic system or when reabsorption of pleural fluid is impaired. Transudates are frequently the result of cardiac failure or conditions resulting in low plasma protein concentrations such as nephrotic syndrome, malnutrition or liver failure. Exudates may result from pneumonia, chest malignancies, tuberculosis, pulmonary embolism and connective tissue diseases.