From the Guidelines
Oral lichen planus can manifest in various forms, including white, lacy patches, red, swollen tissues, open sores, or a combination of these features, and may resemble other conditions such as leukoplakia or lichen sclerosus. The condition can affect different areas of the mouth, including the gums, tongue, lips, and cheeks. Some patients may experience painful erosions or ulcerations, which can cause burning sensations, especially when consuming spicy or acidic foods 1. The lesions are often symmetrical, appearing on both sides of the mouth simultaneously. In some cases, oral lichen planus may present as white plaques or atrophic red areas with a burning sensation, and patients might also experience a metallic taste, bleeding gums, or difficulty eating and drinking.
The appearance of oral lichen planus can vary significantly between individuals, ranging from asymptomatic white reticular patterns to painful erosive lesions that significantly impact quality of life. According to recent guidelines, high-potency topical steroids or tacrolimus are recommended for the management of lichen planus 1. The condition is chronic and may persist for years with periods of flare-ups and remissions, often triggered by stress, certain medications, or dental procedures. It is essential to note that oral lichen planus can be difficult to differentiate from other conditions, such as lichen sclerosus, based on clinical and histological features, and some cases may constitute an overlap syndrome 1.
Key features of oral lichen planus include:
- White, lacy patches or lines on the inside of the cheeks
- Red, swollen tissues, open sores, or a combination of these features
- Painful erosions or ulcerations that can cause burning sensations
- Symmetrical lesions appearing on both sides of the mouth simultaneously
- Resemblance to other conditions, such as leukoplakia or lichen sclerosus
- Variable appearance, ranging from asymptomatic to painful erosive lesions that impact quality of life.
From the Research
Clinical Presentation of Oral Lichen Planus
Oral lichen planus (OLP) can manifest in various forms, including:
- White striations (Wickham's striae) 2
- White papules 2
- White plaque 2
- Erythema (mild to severe) 2, 3
- Erosions 2
- Blisters 2
- Hyperkeratotic striation/reticulation 3
- Mucosal inflammation (ranging from mild erythema to severe widespread ulceration) 3
Classification and Types of Oral Lichen Planus
Several classification systems have been proposed, including:
- Oral lichen planus 3
- Oral lichenoid contact lesions 3
- Oral lichenoid drug reactions 3
- Oral lichenoid lesions of graft vs. host disease 3
- Discoid lupus erythematosus 3
- Systemic lupus erythematosus 3
- Lichen planus-like variant of paraneoplastic pemphigus/paraneoplastic autoimmune multiorgan syndrome 3
- Chronic ulcerative stomatitis 3
- Lichen planus pemphigoides 3
- Solitary fixed drug eruptions 3
- Lichen sclerosus 3
Diagnosis and Treatment
Diagnosis of OLP is established through clinical examination and histopathologic confirmation 2, with direct immunofluorescence examination used as an adjunct to rule out specific autoimmune diseases 2. Treatment options include topical corticosteroids 2, retinoids, tacrolimus, cyclosporine, and photodynamic therapy 2.