What is oral lichen planus (OLP)?
Have you noticed a rash on the inside of your mouth that appears as white or red patches and causes a burning or stinging sensation when you eat or drink? Do you feel like nothing is really helping you with this discomfort? If yes, you may be suffering from a condition called oral lichen planus. A persistent inflammatory condition known as oral lichen planus (OLP) affects the mouth's mucous membranes, notably the lining of the cheeks, gums, tongue, and palate. Even though there is no known cure for oral lichen planus, many treatment options are available that aim to manage the symptoms, reduce inflammation, and provide comfort.
The name Lichen planus arises from the word 'Lichens' which are plants that mainly constitute symbiotic algae and fungi, and the word 'planus' in Latin, means flat. It was first described by British Physician Wilson Erasmus in 1869.3
Lichen planus is an inflammatory mucocutaneous disorder that affects the mucous membranes of skin, hair, nails, and surfaces. The skin and mouth are the most commonly affected areas. Oral lichen planus (OLP) is the one that most commonly affects the buccal mucosa, tongue, and gums, followed by the labial mucosa and lower lip vermilion. Oral lichen planus is typically chronic and requires long-term care and clinical monitoring.1
Although there are many types of oral lichen planus, the two main types are reticular and erosive. Reticular type is the most prevalent form of OLP, and it manifests as an interlacing of white keratotic lines (also called Wickham's striae) with a reddened border whereas erotic OLP appears as red ulcerated patches bordered by keratotic lines.2
Causes of oral lichen planus
It is unknown what causes OLP to develop as well as persist. The current theories focus on an abnormal response to external triggers in contrast to an abnormal response to keratinocyte antigens (autoimmune), however, there is currently a lack of conclusive data that would support this. Other possible causes include viral infections, stress, and local and systemic inducers of cell-mediated hypersensitivity.8
Signs and symptoms of oral lichen planus
The characteristic sign of oral lichen planus is a lesion with radiating pale grey lines that look like blisters and are velvety in texture that is present bilaterally. They may be circular or thread-like, annular, or in the form of patches. Lichen planus oral lesions exhibit in the form of small or very large blisters. It first appears in the mouth several weeks before the onset of skin lesions. Skin lesions are seen in around 15% of people with oral lichen planus.3
Management and treatment for oral lichen planus
Oral lichen planus does not have a specific treatment; however, symptomatic management is advised.4 There are four primary categories of medicinal procedures. These include corticosteroids, retinoids, systemically or topically administered calcineurin inhibitors (cyclosporin and tacrolimus), and ultraviolet (UV) phototherapy. Others include the application of topical anaesthetics for symptomatic relief.7
- Topical application of corticosteroids on the affected area continues to be the most effective form of treatment, while systemically administered corticosteroids may on occasion be recommended for patients with severe erosive OLP or those who have diffuse mucocutaneous involvement. Clobetasol propionate is the most effective topical steroid that may be applied topically and used as a mouthwash, while fluticasone propionate and betamethasone sodium phosphate are also used in the treatment of OLP4
- Several immunosuppressants and novel medications have been proposed to treat OLP which include topical cyclosporine, amitriptyline, amlexanox, curcuminoids and topical thalidomide.5 If you’re pregnant, you should never use topical thalidomide because it can cause serious birth defects
- While full recovery can be challenging to attain with retinoids alone, they often cause negative side effects. Retinoids given topically and systemically in combination with topical corticosteroids may increase the effectiveness of these medications6,7
- PUVA treatment is a therapy that uses UV radiation to cure OLP. It photosensitises and exposes the harmed parts to UVA light 4,7
Diagnosis of oral lichen planus
OLP is diagnosed through a combination of clinical examination, medical history review, and, in certain cases, further tests or procedures like patch testing. The following are the normal stages in diagnosing OLP:
- The clinician will go over the medical history, including any symptoms, any variables that seem to increase or alleviate the symptoms, and any relevant medical conditions or drugs that may be responsible10
- Clinical examination for symptoms such as white lacy patches (reticular type), redness and inflammation (erosive form), ulcers, and other abnormalities in the oral mucosa9
- Histopathologic examination after a biopsy involves looking for the presence of a well-defined band-like zone of cellular infiltration restricted to the superficial connective tissue and composed primarily of lymphocytes9
Can oral lichen planus be prevented?
Since there is no known cause for oral lichen planus, there is currently no proven method to prevent the disease. However, certain measures towards a healthy lifestyle can be taken to prevent oral lichen planus, including reducing stress, maintaining good oral hygiene, regular dental checkups, and avoiding any potential trigger factors such as smoking, tobacco, etc.
How common is oral lichen planus?
Oral lichen planus is a very common condition; however, its true prevalence varies among populations and environments. According to recent research, the prevalence of oral lichen planus ranges between 0.5% and 2.6% in the general population. It is more common in middle-aged and older people, and females are affected more frequently than males.
Is oral lichen planus contagious?
No, oral lichen planus is not contagious; it cannot be transmitted from one person to another. It is believed to be an autoimmune disorder.
When should I see a doctor?
If you suspect you have oral lichen planus (OLP) or have noticed any concerning symptoms in your mouth such as red or white patches, burning or stinging sensations, or difficulty eating or speaking you should see a healthcare professional or a dental specialist for an accurate diagnosis and appropriate management.
Oral lichen planus (OLP) is a chronic inflammatory condition affecting the mouth’s mucous membranes. It can be identified by the appearance of white, lacy lesions or patches that can be painful, and uncomfortable, making it difficult to talk or chew. OLP is believed to be an autoimmune disorder, where the body's immune system mistakenly attacks the cells in the oral mucosa. Although OLP has no specific cure, there are options for treatment that aim to control symptoms, lessen irritation, and enhance the quality of life. The severity of the symptoms and the patient's response to various treatments determine the choice of treatment. Regular monitoring and follow-up with a healthcare expert competent in managing oral disorders are essential to alter the treatment plan as necessary.
- Olson MA, Rogers RS, Bruce AJ. Oral lichen planus. Clinics in Dermatology. 2016 Jul 1;34(4):495–504. [accessed 24 May 2023] Available from: https://www.sciencedirect.com/science/article/pii/S0738081X16300554.
- Edwards PC, Kelsch R. Oral lichen planus: clinical presentation and management. J Can Dent Assoc. 2002; 68(8):494–9. Available fromhttps://scholarworks.iupui.edu/bitstream/handle/1805/3570/Edwards_2002_Oral.pdf?sequence=1
- Krupaa RJ, Sankari SL, Masthan KMK, Rajesh E. Oral lichen planus: An overview. J Pharm Bioallied Sci. 2015 Apr;7(Suppl 1):S158–61. [accessed 24 May 2023] Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4439656.
- Carbone M, Goss E, Carrozzo M, Castellano S, Conrotto D, Broccoletti R, et al. Systemic and topical corticosteroid treatment of oral lichen planus: a comparative study with long-term follow-up: Corticosteroid treatment of oral lichen planus. Journal of Oral Pathology & Medicine. 2003 Jul;32(6):323–9. [accessed 24 May 2023] Available from: http://doi.wiley.com/10.1034/j.1600-0714.2003.00173.x.
- Thongprasom K, Prapinjumrune C, Carrozzo M. Novel therapies for oral lichen planus. J Oral Pathol Med. 2013 Nov;42(10):721–7. [accessed 24 May 2023] Available from: https://onlinelibrary.wiley.com/doi/10.1111/jop.12083
- Carrozzo M, Gandolfo S. The management of oral lichen planus. Oral Diseases. 2008 Jun 28;5(3):196–205. [accessed 24 May 2023] Available from: https://onlinelibrary.wiley.com/doi/10.1111/j.1601-0825.1999.tb00301.x
- Al-Hashimi I, Schifter M, Lockhart PB, Wray D, Brennan M, Migliorati CA, et al. Oral lichen planus and oral lichenoid lesions: diagnostic and therapeutic considerations. Oral Surgery, Medicine, Pathology, Oral Radiology, and Endodontology. 2007 Mar 1;103:S25.e1-S25.e12. [accessed 24 May 2023] Available from: https://www.sciencedirect.com/science/article/pii/S1079210406008602
- Kurago ZB. Etiology and pathogenesis of oral lichen planus: an overview. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 2016 Jul 1;122(1):72–80. [accessed 24 May 2023] Available from: https://www.sciencedirect.com/science/article/pii/S2212440316001061
- Van Der Meij EH, Van Der Waal I. Lack of clinicopathologic correlation in the diagnosis of oral lichen planus based on the presently available diagnostic criteria and suggestions for modifications: Clinicopathologic correlation of oral lichen planus. Journal of Oral Pathology & Medicine. 2003 Oct;32(9):507–12. [accessed 25 May 2023] Available from: http://doi.wiley.com/10.1034/j.1600-0714.2003.00125.x
- Vincent SD, Fotos PG, Baker KA, Williams TP. Oral lichen planus: The clinical, historical, and therapeutic features of 100 cases. Oral Surgery, Oral Medicine, Oral Pathology. 1990 Aug 1;70(2):165–71. [accessed 25 May 2023] Available from: https://www.sciencedirect.com/science/article/pii/0030422090901126