Oral Lichen Planus

Aka: Oral Lichen Planus, Lichen Planus of Buccal Mucosa

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II. Epidemiology

  1. Prevalence: 1-2% in United States
  2. Age usually >40 years (typical range 30 to 60 years old)
  3. Gender predominance: More common in women (2:1 ratio)

III. Pathophysiology

  1. Autoimmune mediated apoptosis of epithelial cells
  2. Involves CD8+ Cytotoxic T-Cells

IV. Risk Factors

  1. Hepatitis C (RR: 6)

V. Symptoms

  1. Often asymptomatic
  2. Oral burning (esp. in erosive type)

VI. Signs

  1. Classic Reticular type (most common)
    1. Distributed symmetrically on posterior Buccal mucosa
    2. Asymptomatic lesions
    3. Appearance
      1. White confluent Papules or
      2. White lacelike (lichenoid) network of striations (Wickham's striae)
  2. Erosive type
    1. Burning or painful erythema, ulcers or bulla
    2. Surrounded by white radiating striae
  3. Desquamative Gingivitis type (Erosive type variation)
    1. Generalized erythema or ulceration of the Gingiva

VII. Associated Conditions

  1. Hepatitis C
    1. May present with Oral Lichen Planus
  2. Lichen Planus of other regions
    1. See Vulvar Lichen Planus
    2. Cutaneous Lichen Planus
      1. Oral Lichen Planus occurs in 50% of patients with cutaneous lesions

VIII. Evaluation

  1. Biopsy lichenoid lesions if not classic appearance
  2. Consider skin Patch Testing for allergans that may provoke the lesions

IX. Differential Diagnosis

  1. See Oral Lesion
  2. Leukoplakia
  3. Localized Oral Lichenoid Reaction
    1. Hypersensitivity Reaction (e.g. dental material)

X. Management

  1. Asymptomatic lesions require no treatement
  2. First-Line: Topical Corticosteroids
    1. Clobetasol (Temovate) gel
    2. Fluocinonide
    3. Corticosteroid oral rinses
  3. Second-Line: Topical Calcineurin Inhibitors
    1. Pimecrolimus
    2. Tacrolimus
  4. Third-Line: Systemic Corticosteroids
    1. Oral Prednisone or Dexamethasone
  5. Other Immunomodulators
    1. Hydroxychloroquine (Plaquenil)
  6. Routine surveillance
    1. May be associated with Oral Cancer risk
    2. Malignant transformation risk in up to 12% of cases (esp. erosive type)

XI. Course

  1. Oral Lichen Planus tends to persist for years and may recur after initial resolution
    1. Contrast with Cutaneous Lichen Planus which often remits spontaneously

XII. References

  1. Ismail (2007) J Oral Sci 49(2): 89-106 [PubMed]
  2. Randall (2022) Am Fam Physician 105(4): 369-76 [PubMed]
  3. Sugerman (2000) Clin Dermatol 18:533-9 [PubMed]

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