Dentistry Book

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Oral Lichen Planus

Aka: Oral Lichen Planus, Lichen Planus of Buccal Mucosa
  1. See Also
    1. Cutaneous Lichen Planus
    2. Vulvar Lichen Planus
  2. 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)
  3. Pathophysiology
    1. Autoimmune mediated apoptosis of epithelial cells
    2. Involves CD8+ Cytotoxic T-Cells
  4. Risk Factors
    1. Hepatitis C (RR: 6)
  5. 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 or ulcers
      2. Surrounded by white radiating striae
    3. Desquamative Gingivitis type (Erosive type variation)
      1. Generalized erythema or ulceration of the Gingiva
  6. Associated Conditions
    1. Hepatitis C
      1. May present with Oral Lichen Planus
    2. Cutaneous Lichen Planus
      1. Oral Lichen Planus occurs in 50% of patients with cutaneous lesions
  7. Evaluation
    1. Biopsy lichenoid lesions if not classic appearance
    2. Consider skin Patch Testing for allergans that may provoke the lesions
  8. Differential Diagnosis
    1. See Oral Lesion
    2. Leukoplakia
    3. Localized Oral Lichenoid Reaction
      1. Hypersensitivity Reaction (e.g. dental material)
  9. 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 (malignant transformation risk in up to 12% of cases)
  10. Course
    1. Oral Lichen Planus tends to persist and recur
      1. Contrast with Cutaneous Lichen Planus which often remits spontaneously
  11. 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]

Lichen Planus (C0023646)

Definition (NCI) A chronic, recurrent, pruritic inflammatory disorder of unknown etiology that affects the skin and mucus membranes. It presents with rashes and papules that tend to resolve spontaneously. It may be associated with hepatitis C. Certain drugs that contain arsenic or bismuth are associated with reactions mimicking lichen planus.
Definition (MSH) An inflammatory, pruritic disease of the skin and mucous membranes, which can be either generalized or localized. It is characterized by distinctive purplish, flat-topped papules having a predilection for the trunk and flexor surfaces. The lesions may be discrete or coalesce to form plaques. Histologically, there is a "saw-tooth" pattern of epidermal hyperplasia and vacuolar alteration of the basal layer of the epidermis along with an intense upper dermal inflammatory infiltrate composed predominantly of T-cells. Etiology is unknown.
Definition (CSP) inflammatory, pruritic disease of the skin and mucous membranes, which can be either generalized or localized; characterized by distinctive purplish, flat-topped papules having a predilection for the trunk and flexor surfaces; lesions may be discrete or coalesce to form plaques.
Concepts Disease or Syndrome (T047)
MSH D008010
ICD9 697.0
ICD10 L43, L43.9
SnomedCT 156377007, 201004002, 4776004
French LICHEN PLAN, Lichen plan
English Lichen Rubra Planus, Lichen Ruber Planus, LICHEN PLANUS, Lichen planus NOS, Lichen planus, unspecified, Lichen Planus, lichen ruber planus, lichen planus (diagnosis), lichen planus, Lichen Planus [Disease/Finding], Lichen planus NOS (disorder), Lichen planus, Ruber planus, LP - Lichen planus, Lichen planus (disorder), Wilson; lichen ruber, lichen ruber; Wilson, lichen; planus, of Wilson, lichen; planus, lichen; ruber planus, planus; lichen ruber planus, planus; lichen, of Wilson, planus; lichen, ruber; lichen ruber planus, Lichen, ruber planus
Portuguese LIQUEN PLANO, Líquen plano, Líquen Plano, Líquen Plano Rubro
Spanish LIQUEN PLANO, liquen plano, SAI, liquen plano, SAI (trastorno), liquen plano (trastorno), liquen plano, Liquen plano, Liquen Plano, Liquen Rojo Plano
German LICHEN PLANUS, Lichen ruber planus, nicht naeher bezeichnet, Lichen planus, Lichen ruber planus
Swedish Lichen planus
Japanese ﾍﾝﾍﾟｲﾀｲｾﾝ, 苔癬-扁平, 紅色苔癬, 扁平紅色苔癬, 扁平苔癬, 苔癬-扁平紅色
Czech lichen ruber planus, lichen planus, Lichen planus
Finnish Punajäkälä
Russian LIKHEN PLOSKII, KRASNYI PLOSKII LISHAI, LISHAI PLOSKII, КРАСНЫЙ ПЛОСКИЙ ЛИШАЙ, ЛИХЕН ПЛОСКИЙ, ЛИШАЙ ПЛОСКИЙ
Italian Lichen ruber planus, Lichen planus
Korean 편평태선, 상세불명의 편평태선
Croatian LICHEN PLANUS
Polish Liszaj płaski, Liszaj czerwony płaski
Hungarian Lichen planus
Norwegian Lichen ruber planus, Lichen planus
Dutch Wilson; lichen ruber, lichen ruber; Wilson, lichen; planus, van Wilson, lichen; planus, lichen; ruber planus, planus; lichen ruber planus, planus; lichen, van Wilson, planus; lichen, ruber; lichen ruber planus, Lichen planus, niet gespecificeerd, lichen planus, Lichen planus, Lichen ruber planus
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Lichen Planus, Oral (C0206139)

Definition (NCI) A chronic, autoimmune inflammatory condition of the mucous membranes in the oral cavity that affects approximately two percent of the population and is most often seen in middle aged women. It is characterized by white, lacy patches; red, swollen tissue; papules and plaques; or open sores. The lesions are typically bilateral.
Definition (MSH) Oral lesions accompanying cutaneous lichen planus or often occurring alone. The buccal mucosa, lips, gingivae, floor of the mouth, and palate are usually affected (in a descending order of frequency). Typically, oral lesions consist of radiating white or gray, velvety, threadlike lines, arranged in a reticular pattern, at the intersection of which there may be minute, white, elevated dots or streaks (Wickham's striae). (Jablonski, Illustrated Dictionary of Dentistry)
Concepts Disease or Syndrome (T047)
MSH D017676
SnomedCT 235049008
English Lichen Planus, Oral, Lichen Planus, Oral [Disease/Finding], lichen planus oral, lichen oral planus, oral lichen planus, Oral lichen planus, OLP - Oral lichen planus, Oral lichen planus (disorder), Oral Lichen Planus
Japanese 口腔扁平苔癬, ｺｳｸｳﾍﾝﾍﾟｲﾀｲｾﾝ
Swedish Lichen planus, oral
Czech lichen planus orální, Orální lichen planus
Finnish Suun punajäkälä
Russian LISHAI PLOSKII ORAL'NYI, LISHAI PLOSKII ROTOVOI POLOSTI, ЛИШАЙ ПЛОСКИЙ ОРАЛЬНЫЙ, ЛИШАЙ ПЛОСКИЙ РОТОВОЙ ПОЛОСТИ
Croatian LICHEN PLANUS, ORALNI
Polish Liszaj płaski jamy ustnej
Hungarian Oralis lichen planus
Norwegian Lichen Planus, oral
Portuguese Líquen Plano Oral, Líquen plano oral, Líquen Plano Bucal
Spanish liquen plano bucal (trastorno), liquen plano bucal, liquen plano oral, Liquen plano oral, Liquen Plano Oral
Dutch orale lichen planus, Lichen planus, orale, Orale lichen planus
German oraler Lichen planus, Lichen planus, oraler
French Lichen plan buccal, Lichen plan de la cavité buccale, Lichen plan oral
Italian Lichen planus orale
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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