From the Guidelines
The fountain sign in lichen planus is a diagnostic feature that represents Wickham's striae, which are fine, lacy, reticular white lines that form a network-like pattern on the surface of lichen planus lesions, and is most commonly observed in oral lichen planus, particularly on the buccal mucosa, tongue, and gingiva 1. The fountain sign is a characteristic clinical finding in lichen planus, and its presence can aid in the diagnosis of this condition. According to the NCCN guidelines, high-potency topical steroids, such as clobetasol 0.05% or fluocinonide 0.05% (cream or ointment), or tacrolimus (0.1% ointment) are recommended for the treatment of lichen planus and lichenoid diseases 1. Some key points to consider when evaluating the fountain sign in lichen planus include:
- The fountain sign is a diagnostic feature that represents Wickham's striae, which are fine, lacy, reticular white lines that form a network-like pattern on the surface of lichen planus lesions 1.
- The fountain sign is most commonly observed in oral lichen planus, particularly on the buccal mucosa, tongue, and gingiva 1.
- The presence of the fountain sign can aid in the diagnosis of lichen planus, and its absence does not rule out the condition 1.
- The NCCN guidelines recommend high-potency topical steroids, such as clobetasol 0.05% or fluocinonide 0.05% (cream or ointment), or tacrolimus (0.1% ointment) for the treatment of lichen planus and lichenoid diseases 1. The treatment of lichen planus should focus on reducing symptoms and improving quality of life, and the use of high-potency topical steroids or tacrolimus is a recommended approach 1.
From the Research
Fountain Sign in Lichen Planus
- The fountain sign is a clinical feature that can be observed in oral lichen planus (OLP)
- However, there is no direct mention of the fountain sign in the provided studies 2, 3, 4, 5, 6
Clinical Features and Diagnosis of Oral Lichen Planus
- Oral lichen planus (OLP) is a chronic inflammatory disease characterized by a T-cell mediated, epithelium-directed inflammation in response to unknown antigen(s) 5
- The disease evolves by intermittent flares and displays polymorphous clinical features (reticular, erosive, atrophic, plaque, papular, bullous, etc.) 5
- Symptoms vary depending on the clinical form and range from discomfort to severe pain 5
Treatment of Oral Lichen Planus
- Topical superpotent corticosteroids constitute the first-line treatment of symptomatic flares 5
- A wide range of second/third-line treatments are available among topical calcineurin inhibitors, systemic corticosteroids, systemic retinoids, topical/systemic immunomodulators, etc. 5
- The combination of oral acitretin and topical triamcinolone acetonide was more effective than topical triamcinolone acetonide monotherapy in patients with symptomatic OLP 4
- Topical purslane (Portulaca oleracea) can be a safer alternative long-term drug for the management of OLP 3