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Oral Lichen Planus
Aka: Oral Lichen Planus, Lichen Planus of Buccal Mucosa
- See Also
- Cutaneous Lichen Planus
- Vulvar Lichen Planus
- 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)
- Pathophysiology
- Autoimmune mediated apoptosis of epithelial cells
- Involves CD8+ Cytotoxic T-Cells
- Risk Factors
- Hepatitis C (RR: 6)
- 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 or ulcers
- Surrounded by white radiating striae
- Desquamative Gingivitis type (Erosive type variation)
- Generalized erythema or ulceration of the Gingiva
- Associated Conditions
- Hepatitis C
- May present with Oral Lichen Planus
- Cutaneous Lichen Planus
- Oral Lichen Planus occurs in 50% of patients with cutaneous lesions
- Evaluation
- Biopsy lichenoid lesions if not classic appearance
- Consider skin Patch Testing for allergans that may provoke the lesions
- Differential Diagnosis
- See Oral Lesion
- Leukoplakia
- Localized Oral Lichenoid Reaction
- Hypersensitivity Reaction (e.g. dental material)
- Management
- Asymptomatic lesions require no treatement
- First-Line: Topical Corticosteroids
- Clobetasol (Temovate) gel
- Fluocinonide
- Corticosteroid oral rinses
- Second-Line: Topical Calcineurin Inhibitors
- Pimecrolimus
- Tacrolimus
- Third-Line: Systemic Corticosteroids
- Oral Prednisone or Dexamethasone
- Other Immunomodulators
- Hydroxychloroquine (Plaquenil)
- Routine surveillance
- May be associated with Oral Cancer risk (malignant transformation risk in up to 12% of cases)
- Course
- Oral Lichen Planus tends to persist and recur
- Contrast with Cutaneous Lichen Planus which often remits spontaneously
- References
- Ismail (2007) J Oral Sci 49(2): 89-106 [PubMed]
- Randall (2022) Am Fam Physician 105(4): 369-76 [PubMed]
- Sugerman (2000) Clin Dermatol 18:533-9 [PubMed]