Oral Lichen Planus
Exodontia.Info
What is Lichen Planus?

Lichen Planus is a long-term disease, which can affect the skin and mouth and, in some cases, the genital area.

It affects 1 - 2% of men and women in the UK and is more common in people over 40-years old.

It is not a cancer or an infectious disease that can be passed on and it does not run in families.

What is the Cause of Lichen Planus?

The cause of Lichen Planus is not known but it is probably related to the immune system where cells that normally
fight off germs attack normal parts of the body.

Certain drugs used in the treatment of high blood pressure, arthritis and diabetes may cause
Lichen Planus-like
lesions.

Also, where the cheeks or tongue have been lying against teeth have amalgam restorations,
Lichen Planus-like
lesions may occur.  Emotional stress and spicy foods or citrus fruits can often cause symptoms to worsen.

It is not thought to be infectious.

What are the signs and symptoms?

Lichen Planus appears in a wide variety of ways and can cause pain, burning and/or soreness in the mouth.

It can often go unnoticed and may only be recognised by a dentist or hygienist during a routine examination.  White,
net-like lines or white patches are usually seen on the inside of both cheeks and can also appear on the tongue and
gums.  These do not usually cause any discomfort.

In some cases, red patches, ulcers or blisters appear which can be painful.  The gums can also become thin, red
and shiny in appearance and it may hurt to brush your teeth.  About one third of people also get a purple, itchy rash
with raised dots on the skin, especially on the wrists and shins.  Very rarely, changes can be seen in the genital
area, hair and nails.
Photos of Oral Lichen Planus affecting the tongue & buccal mucosæ
How Is It Diagnosed?

Blood tests and a biopsy of an affected area may be required.

How is it treated?

As long as there is no pain, treatment is not usually necessary.  In all cases, it is important to keep your mouth
clean, as it stops the
Lichen Planus from getting infected.

There are many different treatments available for treating the condition if it is causing a problem.

The usual treatment is
steroid medication and / or antiseptic / pain-relieving mouthwashes.  These are not
absorbed into the body as they only work on the area they are applied to and therefore cause no side effects.

It may be an idea to try to identify factors that make the problem worse, e.g. stress, spicy food such as chillies,
citrus fruit and strongly-flavoured toothpastes (containing
cinnamonaldehyde).

In severe cases, the hospital doctor will prescribe some stronger medication.

Prognosis.

Most
lichen planus is benign.  There are some forms of lichen planus that may rarely, after years, lead to a
tumour; in this case, have yourself checked regularly if the specialist advises.
Last Updated 6th March 2020
Treatment Algorithm for Oral Lichen Planus
Useful Websites:

International Lichen Planus Support Group Web

American Academy of Dermatology

British Association of Dermatology

NHS Choices

Wikipedia

British Association of Oral Medicine

BMJ Best Practice

Cochrane Review

BDJ

Emedicine

NICE



Useful Articles:

NEJM 1990.  Effect of Topical Cyclosporine Rinse on Oral Lichen Planus

Eastman Dental Institute Oral Medicine Clinic.  Oral Lichen Planus Patient Information Sheet.  1999.

Am J Clin Dermatol 2000.  Management of Oral Lichen Planus

Dental Update 2002.  Oral Lichenoid Drug Eruptions: Their Recognition and Management.

J Can Dent Ass 2002.  Oral Lichen Planus - Clinical Presentation and Management

Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004.  Healing of oral lichenoid lesions after replacing amalgam
restorations: A systematic review.

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology & Endodontology 2005.  Current controversies in oral
lichen planus: Report of an international consensus meeting. Part 1. Viral infections and etiopathogenesis.

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology & Endodontology 2005.  Current controversies in oral
lichen planus: Report of an international consensus meeting. Part 2. Clinical management and Malignant
Transformation.

2005.  Oral Lichenoid Lesions - More than Mercury

Arch Dermatol 2007.  Oral Lichen Planus.  A Case Series with Emphasis on Therapy

Evidence-Based Dentistry 2008.  How Common is Oral Lichen Planus

British Society for Oral Medicine 2010.  Guidelines for the Management of Oral Lichen Planus In Secondary Care

Am Fam Physician 2011.  Diagnosis and Treatment of Lichen Planus

Cochrane Database Syst Rev 2011.  Insufficient evidence for effectiveness of any treatment for oral lichen planus

J Oral Maxillofac Pathol 2011.  Oral Lichen Planus - An Update on Pathogenesis and Treatment

Curr Pharmaceutic Des 2012.  Topical Therapies for Oral Lichen Planus Management & their Efficacy - A Narrative
Review

J Med Sci 2014.  Oral Lichen Planus - Different Trends in Treatment

World J Stomatol 2015.  Oral Lichen Planus - Etiology, Pathogenesis, Diagnosis & Management

Dental Update 2019.  Lichen Planus − The Role of the General Dental Practitioner