II. Epidemiology
- Prevalence: 1-2% in United States
- Age usually >40 years (typical range 30 to 60 years old)
- Gender predominance: More common in women (2:1 ratio)
III. Pathophysiology
- Autoimmune mediated apoptosis of epithelial cells
- Involves CD8+ Cytotoxic T-Cells
IV. Risk Factors
- Hepatitis C (RR: 6)
V. Symptoms
- Often asymptomatic
- Oral burning (esp. in erosive type)
VI. Signs
- Classic Reticular type (most common)
- Distributed symmetrically on posterior Buccal mucosa
- Asymptomatic lesions
- Appearance
- White confluent Papules or
- White lacelike (lichenoid) network of striations (Wickham's striae)
- Erosive type
- Burning or painful erythema, ulcers or bulla
- Surrounded by white radiating striae
- Desquamative Gingivitis type (Erosive type variation)
VII. Associated Conditions
-
Hepatitis C
- May present with Oral Lichen Planus
-
Lichen Planus of other regions
- See Vulvar Lichen Planus
- Cutaneous Lichen Planus
- Oral Lichen Planus occurs in 50% of patients with cutaneous lesions
VIII. Evaluation
- Biopsy lichenoid lesions if not classic appearance
- Consider skin Patch Testing for allergans that may provoke the lesions
IX. Differential Diagnosis
- See Oral Lesion
- Leukoplakia
- Localized Oral Lichenoid Reaction
- Hypersensitivity Reaction (e.g. dental material)
X. Management
- Asymptomatic lesions require no treatement
- First-Line: Topical Corticosteroids
- Clobetasol (Temovate) gel
- Fluocinonide
- Corticosteroid oral rinses
- Second-Line: Topical Calcineurin Inhibitors
- Third-Line: Systemic Corticosteroids
- Oral Prednisone or Dexamethasone
- Other Immunomodulators
- Routine surveillance
- May be associated with Oral Cancer risk
- Malignant transformation risk in up to 12% of cases (esp. erosive type)
XI. Course
- Oral Lichen Planus tends to persist for years and may recur after initial resolution
- Contrast with Cutaneous Lichen Planus which often remits spontaneously