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Oral lichen planus

Author: Kim Gear, Oral Medicine Trainee, Auckland, New Zealand, 2007.

What is oral lichen planus?

Oral lichen planus is lichen planus inside the mouth.

Lichen planus is a chronic inflammatory skin condition affecting about 1-2% of the adult population. It usually affects adults older than 45 years, although it may affect younger adults and children. It is more common in women than in men (1.4: 1).

Oral lichen planus affects 50% of patients with skin lichen planus but may occur without skin lesions elsewhere. All areas inside the mouth can be affected. There may be no symptoms but it can cause discomfort, lumps and ulcers.

Clinical features of oral lichen planus

Oral lichen planus may present in the following forms, and is often of mixed types.

Reticular lichen planus
  • Symmetrical white lace-like pattern on buccal mucosa (inner aspects of cheeks)
  • May affect tongue or gums
  • May ulcerate
Atrophic/erosive lichen planus
  • Red lesions often with a whitish border
  • My cause erosions (superficial ulceration)
  • Most often affects the gums (gingiva) and lips
  • Can be very painful
Plaque type
  • Usually seen in smokers
  • Confluent white patches similar to oral keratoses

What is the cause of oral lichen planus?

The precise cause of oral lichen planus is unknown. It appears to be an autoimmune disease in which cells called CD8+ T lymphocytes, and chemical mediators such as the cytokine TNF, attack the oral epithelial cells resulting in their death.

In most cases the disease appears unexpectedly and is called idiopathic oral lichen planus. In other cases it may be precipitated by the following:

Oral lichenoid lesions are also part of the spectrum of chronic graft-versus-host disease that occurs after bone marrow transplantation.

How is the diagnosis of oral lichen planus made?

The diagnosis of oral lichen planus is often made by its clinical appearance. However tissue biopsy may be helpful, when characteristic features of lichen planus may be observed.

Under the microsope, the pathologist may observe a characteristic lichenoid reaction. Direct immunofluorescence may reveal positive staining for fibrinogen, immunoglobulins and complement.

Biopsy is often performed to rule out oral cancer.

Complications of oral lichen planus

Oral lichen planus can be very painful and ulceration may lead to scarring. Sometimes eating is so uncomfortable that affected person is unable to maintain adequate nutrition.

Lichen planus may rarely lead to oral cancer (squamous cell carcinoma). Persistent ulcers and enlarging nodules should undergo biopsy.

Management of oral lichen planus

It is important to identify and remove any potential agent that might have caused a lichenoid reaction, such as drugs that have been started in recent months and contact allergens identified by patch testing.

Most people get satisfactory control of symptoms with the following measures:

In severe cases systemic corticosteroids may be used.

Other possible therapeutic agents may include:

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