Oral Lichen Planus: Symptoms, Causes, Treatment

What are the symptoms of oral lichen planus?

Oral lichen planus is a chronic inflammatory condition that affects the mucous membranes inside the mouth. It can present in various forms and may have different symptoms depending on the individual. Here are the common symptoms:

Symptoms of Oral Lichen Planus:

• White Patches:
• Lacy, white lines (known as Wickham striae) on the inside of the cheeks, tongue, gums, or other areas of the mouth.
• Red or Purple Lesions:
• In some cases, lesions may appear red or purple and can be flat or raised.
• Pain or Discomfort:
• Some individuals may experience burning sensations, tenderness, or pain, especially when consuming spicy, acidic, or hot foods.
• Ulcerations:
• Sores may develop in the mouth, which can be painful and may take time to heal.
• Dry Mouth:
• Reduced saliva production can lead to a dry mouth sensation.
• Swelling:
• The affected areas of the mouth may appear swollen or inflamed.
• Difficulty Eating or Difficulty Swallowing:
• Pain or discomfort may make it challenging to eat certain foods.

Summary:

Oral lichen planus can vary in severity, and symptoms may flare up or improve over time. If you suspect you have oral lichen planus or are experiencing any of these symptoms, it’s important to consult a healthcare provider or dentist for an accurate diagnosis and appropriate management.

What are the causes of oral lichen planus?

The exact cause of oral lichen planus is not fully understood, but it is believed to be related to several factors. Here are some potential causes and contributing factors:

Causes of Oral Lichen Planus:

• Autoimmune Response:
• Oral lichen planus is thought to be an autoimmune condition, where the immune system mistakenly attacks the cells of the oral mucosa.
• Genetic Factors:
• A family history of lichen planus or other autoimmune diseases may increase the risk.
• Infection:
• Some viral infections, such as hepatitis C, have been associated with oral lichen planus.
• Allergic Reactions:
• Allergies to certain substances, including dental materials (e.g., metals like nickel), flavors, or medications, may trigger or exacerbate the condition.
• Stress:
• Physical or emotional stress may play a role in the onset or exacerbation of symptoms.
• Medications:
• Certain medications, including nonsteroidal anti-inflammatory drugs (NSAIDs) and beta-blockers, have been reported to trigger lichen planus in some individuals.
• Other Skin Conditions:
• Individuals with other forms of lichen planus on the skin may also develop oral lichen planus.

Summary:

While the precise cause of oral lichen planus remains unclear, it is likely a combination of genetic predisposition, immune system dysfunction, and environmental triggers. If you suspect you have oral lichen planus or are experiencing symptoms, it is important to consult a healthcare provider or dentist for an accurate diagnosis and appropriate management.

How is the diagnosis of oral lichen planus made?

The diagnosis of oral lichen planus is primarily clinical and involves a combination of patient history, physical examination, and sometimes additional laboratory tests or procedures. Here’s a detailed overview of the diagnostic process:

1. Medical History:

• The healthcare provider will take a thorough medical history to understand the patient’s symptoms, duration, and any potential triggers. This includes:
  • Description of oral symptoms (e.g., pain, burning, lesions).
  • Any associated symptoms.
  • Family history of autoimmune diseases or other relevant conditions.
  • History of medications, allergies, or known irritants.

2. Clinical Examination:

• A visual examination of the oral cavity will be performed to look for characteristic lesions. The provider will look for:
  • White, lacy patches (Wickham’s striae).
  • Red or swollen areas.
  • Erosive lesions or ulcerations.
• The location of lesions and their appearance are critical for diagnosis.

3. Differential Diagnosis:

• The clinician will consider other possible conditions that could present with similar oral lesions, such as:
  • Oral candidiasis (thrush).
  • Geographic tongue.
  • Lichenoid mucositis (triggered by dental materials or medications).
  • Erythema multiforme.
• A careful comparison of the clinical features will help rule out these conditions.

4. Biopsy:

• In some cases, particularly when the diagnosis is uncertain or when the lesions appear atypical, a biopsy of the affected tissue may be performed. A small sample of tissue is taken and examined histopathologically.
• The biopsy findings in oral lichen planus can show features such as:
  • A band-like infiltrate of lymphocytes at the junction between the epithelium and connective tissue (the basement membrane zone).
  • Degeneration of the basal cell layer.
• This histological analysis helps confirm the diagnosis.

5. Laboratory Tests:

• While specific laboratory tests for oral lichen planus do not exist, tests may be ordered to check for associated conditions, such as:
  • Blood tests for autoimmune diseases.
  • Tests for hepatitis C if clinically indicated, as there’s an association between hepatitis C and oral lichen planus.

6. Monitoring and Follow-Up:

• Follow-up appointments may be necessary to monitor the condition, assess the effectiveness of treatments, and evaluate any changes in lesions over time.

Conclusion

Diagnosing oral lichen planus involves a comprehensive approach that combines clinical observation with potential histological evaluation. If oral lichen planus is suspected, it’s important to consult healthcare professionals, such as a dentist or an oral medicine specialist, who can provide an accurate diagnosis and appropriate management.

What is the treatment for oral lichen planus?

The treatment of oral lichen planus (OLP) focuses on alleviating symptoms, reducing inflammation, and preventing complications, as the condition itself is often chronic and may fluctuate over time. Since OLP can vary in severity and presentation, the treatment approach may differ from one patient to another. Here are some common treatment options:

1. Topical Treatments:

• Corticosteroids: Topical corticosteroids are often the first line of treatment. They help reduce inflammation and alleviate pain associated with lesions. Common topical corticosteroids include:
  • Fluocinonide
  • Clobetasol propionate
  • Triamcinolone acetonide
• Corticosteroid Ointments/Gels: These can be applied directly to the lesions for localized treatment.
• Corticosteroid Rinses: In some cases, mouth rinses containing corticosteroids (e.g., dexamethasone) may be prescribed.

2. Systemic Treatments:

• For more severe cases or those that do not respond to topical treatments, systemic corticosteroids may be considered. This involves oral or injected steroids to help control symptoms.
• Immunomodulators: Medications such as azathioprine or mycophenolate mofetil may be used in cases that are resistant to traditional treatments.

3. Pain Management:

• Analgesics such as topical anesthetics may be used to relieve pain and discomfort.
• Over-the-counter pain relief medications (e.g., ibuprofen or acetaminophen) can also be helpful.

4. Addressing Precipitating Factors:

• If specific factors are identified that exacerbate OLP (e.g., certain medications, dental materials), efforts should be made to avoid these triggers.

5. Good Oral Hygiene:

• Maintaining excellent oral hygiene is vital to prevent secondary infections and manage symptoms. Patients are encouraged to use gentle oral care products.

6. Monitoring and Regular Follow-Up:

• Regular follow-up appointments with a healthcare provider are essential for monitoring the condition and adjusting treatment as necessary.

7. Lifestyle Modifications:

• Some patients may benefit from dietary changes, stress management techniques, and smoking cessation, as these factors may aggravate symptoms.

8. Alternative Treatments:

• Some patients explore alternative therapies, such as herbal remedies or acupuncture, but these should be approached with caution and discussed with a healthcare provider.

Note on Oral Lichen Planus and Cancer Risk:

Patients with oral lichen planus are at a slightly increased risk of developing oral squamous cell carcinoma (OSCC), particularly in areas of erosive or ulcerative lesions. Regular oral examinations are crucial for early detection of any malignant changes.

Conclusion

Treatment of oral lichen planus is highly individualized, and it’s essential for patients to work closely with their healthcare provider—such as a dentist, oral medicine specialist, or dermatologist—to develop a management plan tailored to their specific needs and symptoms. If you suspect you have oral lichen planus or have been diagnosed with it, please consult a healthcare professional for guidance and treatment options.