Oral Lichen Planus

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.