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Oral lichen planus is a chronic condition affecting the inside of the mouth. It typically occurs as white, lacy patches, swollen red tissues, or open sores on the inner cheeks, gums, and tongue. This may lead to sensations of burning, pain, or other forms of discomfort.
Lichen planus can manifest on various mucosal surfaces throughout the body. However, when it occurs in the mouth, it is specifically termed oral lichen planus. It often arises when the immune system unexpectedly attack against cells in the oral mucous membranes.
Although this condition cannot be transmitted from one person to another or considered dangerous, it can cause discomfort. Individuals with symptoms may require medication to alleviate them. In some cases, regular monitoring may be required due to the potential risk of developing mouth cancer in the affected areas.
Symptoms
Oral lichen planus typically forms in two distinct ways: bright red gum tissue or white, web-like lesions. The common locations for these lesions include the inside of the cheeks, gums, tongue, inner tissues of the lips, and the palate.
The symptoms may be divided into two categories:
- Reticular oral lichen planus: Most cases of these are not painful. On the inside of the cheeks, this type typically manifests as white patches or lesions that resemble threads. These regions are usually elevated slightly.
- Erosive oral lichen planus: Those who have this condition occasionally have gum tissue that is a vivid red color. In severe cases, one may get ulcers on the tongue, gums, or mouth floor. For those who have erosive oral lichen planus, eating and drinking hot, spicy, or acidic foods or beverages might be uncomfortable. They may experience a burning sensation or pain, bleeding and irritation during tooth brushing, gingivitis, painful and thickened patches on the tongue, as well as discomfort when speaking, chewing, or swallowing.
In addition to oral lichen planus, lichen planus lesions can affect various parts of the body, leading to different symptoms:
- Genital: Genital lesions, especially in females, may lead to pain, burning, and discomfort during intercourse, often presenting as red or eroded patches, occasionally exhibiting whitish areas. Similar lesions can also manifest on male genitalia.
- Skin: It can appear as itchy, purplish, flat-topped bumps.
- Scalp. On the scalp, the presence of skin lesions can result in either temporary or permanent hair loss.
- Nails: Toenails or fingernails may show ridges, thinning, or splitting, leading to temporary or permanent nail loss.
- Ears: This may be affected, potentially causing hearing loss.
- Eyes: Lichen planus can cause scarring and blindness.
- Esophagus: Lichen planus may result in narrowing or the formation of tight, ringlike bands, making swallowing difficult when it occurs.
If there is a white, thread-like lesions or red patches in the mouth, or if any of the signs and symptoms occur, consult a healthcare provider for proper diagnosis and treatment.
Causes
The cause of oral lichen planus is not fully understood, but it is believed to be influenced by genetic factors and the immune system. It indicates that T lymphocytes, a type of white blood cell associated with inflammation, may be activated in this condition.
Certain medications, including beta-blockers and nonsteroidal anti-inflammatory drugs (NSAIDs), can trigger its development. Additionally, specific diseases like hepatitis B and primary biliary cirrhosis may be associated with oral lichen planus. Other triggering factors also include allergy-causing agents such as dental materials, mouth injuries, and infections.
Risk factors
Oral lichen planus can affect anyone, but women are twice as prone to developing the condition compared to men. The majority of cases of oral lichen planus are observed in adults aged 50 and older.
Although more studies are required to establish the contributing factors to its occurrence, it is believed that having an immune-lowering disorder or using specific medications may elevate the risk of developing this condition.
Diagnosis
The diagnosis of oral lichen planus involves a comprehensive approach. It may include a discussion of one’s medical and dental history, review of symptoms, including mouth lesions, and conduct of a physical examination of the mouth and other relevant areas if needed. In most cases, some tests and a biopsy is required to confirm the diagnosis and rule out other diseases.
Tests that may be ordered include:
- Blood tests: Lupus, a condition that may exhibit similarities to oral lichen planus, and hepatitis C, which is rarely associated with oral lichen planus may be identified through this test.
- Biopsy: To detect signs of oral lichen planus, a laboratory analysis of the tissue is necessary. This involves extracting a small tissue sample from one or multiple lesions in the oral cavity. Specialized microscopic tests may also be necessary to pinpoint immune system proteins commonly linked to this condition.
- Cultures: To check for the presence of any secondary fungal, bacterial, or viral infections, a cell sample from the mouth may be obtained, followed by microscopic examination.
Treatment
There is no definite treatment for oral lichen planus. Available treatment aims to lessen pain and discomfort while promoting the healing of severe lesions. Mild cases often resolve on their own, particularly when triggering medications are discontinued. In more severe cases, medication may be recommended.
Mild cases may require monitoring. If symptoms worsen, specific strategies may be suggested to manage flare-ups. Treatment options include:
- Symptomatic treatment: Corticosteroids are treatment options to reduce inflammation, with various forms available: topical, oral, or injection. The choice of form depends on the severity of the condition, and side effects vary based on the method of use.
The topical form of corticosteroids is applied through mouthwash, ointment, or gel directly on the mucous membrane. Oral pills is recommended for a limited duration, and injections are administered directly into the lesions. - Immune response medicines: Medications in the form of topical ointments or gels, and systemic medications may be prescribed to manage severe cases of oral lichen planus. These medications can improve lesions and alleviate pain by suppressing or modifying the body’s immune response.
Regular follow-up visits with a primary care provider during treatment are essential to monitor for secondary infections since the use of topical steroids can lead to yeast overgrowth. Prompt treatment is necessary as untreated infections may exacerbate the condition.- Topical ointments or gels:Although this comes with a warning due to a potential unclear association with cancer, these medications have shown effectiveness with treating oral lichen planus. Examples of these medications include calcineurin inhibitors like tacrolimus and pimecrolimus.
- Systemic medication:These medications may be used for severe cases involving other areas like the scalp, genitalia, or esophagus.
- Handling triggers: These are often necessary when the oral lichen planus is linked to a trigger, like a medication, an allergen, or stress. Alternative medications, testing for allergens, and techniques for managing stress may be recommended by a healthcare provider.
