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Oral lichen planus

Definition


Disease: Oral lichen planus Oral lichen planus
Category: Dermatological diseases

Disease Definition:

Oral lichen planus usually occurs on the inside of a person’s cheeks, but it could also affect the gums, tongue, lips and other parts of the mouth. This condition can be defined as a chronic autoimmune inflammatory case affecting the lining of the mouth, often causing characteristic lacy white patches. Occasionally, oral lichen planus involves the throat or esophagus. It often begins throughout midlife, but it could also occur at any age.

 

A primary episode of oral lichen planus might linger for weeks or months. But unfortunately, oral lichen planus is often a chronic case and could linger for many years. This condition can be managed with home remedies and medications despite the fact that it doesn’t have a cure.
 

Work Group:


Symptoms, Causes

Symptoms:

Signs and symptoms of oral lichen planus might include one or more of the below:

 

  • Mouth pain
  • Red, open sores in the mouth
  • Shiny, red, slightly raised patches on the tongue or cheeks
  • Dry mouth
  • Burning in the mouth
  • Sore gums
  • Small, pale raised areas or bumps forming a lacy network on the tongue or inside the cheeks
  • Burning, swelling, bleeding and irritation with tooth brushing
  • A metallic taste or a blunted taste sensation
  • Sensitivity to hot or spicy foods
  • A rough feeling in the mouth

 

While occasionally oral lichen planus results in no signs or symptoms other than the raised areas or patches, but it often causes only a limited lacy network of pale, slightly raised areas or shiny, red, raised patches on the sides of the tongue or inside the cheeks. Less frequently, it might turn into a painful erosive lesion or ulcer. People with this condition may have periods when they’re symptom-free, alternating with periods when their symptoms flare up.

 

When having oral lichen planus, the affected person might also have the skin form named lichen planus. They might notice lesions on other parts of their body including their skin, scalp, genitals and nails.

 

The patient should see a doctor or dentist if he/she:

 

  • Has mouth pain
  • Experiences a loss of feeling inside the mouth
  • Notices sores inside the mouth that don’t heal
  • Develops lesions or sores on the skin, scalp, genitals or nails
  • Has repeated bleeding in the mouth
  • Has lumps or white, red or dark patches in the mouth
  • Notices any change in the way their mouth looks and feels
     

Causes:

It is not clear why exactly oral lichen planus occurs, but mounting research evidence suggests that oral lichen planus is an autoimmune condition that occurs when the body’s immune system triggers a chronic inflammatory procedure in the mucous membranes. It is considered that this procedure affects certain skin cells, such as those in the mouth.

 

Factors increasing the risk of oral lichen planus might include the following:

Medications:

Oral lichen planus might be triggered by certain medications, such as those used in treating arthritis, heart disease, high blood pressure and malaria.

Sex:

Oral lichen planus is more likely to affect women than men.

Psychological issues:

Oral lichen planus is usually accompanied by stress, depression and anxiety which might worsen existing conditions.

Allergies:

An allergic reaction to food, food additives, dyes, dental metals, fragrances or other substances could cause oral lichen planus.

Betel quid:

Chewing betel quid, a plant and nut combination common in Southeast Asia, might increase a person’s risk of oral lichen planus.

Dental issues:

Someone’s risk of oral lichen planus may be increased due to sharp edges on the teeth, dental restorations, ill-fitting dental prostheses, some periodontal surgical procedures, and oral habits like lip and cheek chewing.

Medical conditions:

Oral lichen planus is associated with certain medical conditions, such as other immune disorders. These might include:

 

  • Lichen planus of the skin
  • Liver disease
  • Primary sclerosing cholangitis
  • Graft-versus-host disease
  • Lupus erythematosus
  • Sjogren’s syndrome
  • Primary biliary cirrhosis
  • Alopecia areata
  • Myasthenia gravis
  • Ulcerative colitis
     

Complications

Complications:

Besides pain and taste changes that might accompany oral lichen planus, the condition might also result in or be related with complications such as:

Oral thrush:

The risk of this fungus infection also called Candida albicans may be increased due to oral lichen planus and its treatment. Sometimes, it could become resistant to antifungal medications, causing a so-called superinfection that’s hard to manage.

Squamous cell carcinoma:

This is a type of skin or mucous membrane cancer. Since evidence has been mixed, there is considerable argument about whether oral lichen planus could raise the risk of this cancer or not. The risk seems to be increased with tobacco use and with ulcerative types of oral lichen planus.
 

Treatments:

Oral lichen planus doesn’t have a cure. Managing the pain, decreasing lesions and prolonging the periods of time when the patient is symptom-free is what medical treatment focuses on.

 

MILD SYMPTOMS:

The severity of the symptoms and the underlying cause, if determined, is what the treatment pattern of oral lichen planus will be based on. The patient might not need any treatment other than home remedies in case he/she experiences mild symptoms. Yet, they should have periodic exams to make certain their condition is not getting worse. Additionally, a person’s symptoms may improve with the treatment of the underlying condition if there is one.

 

MORE BOTHERSOME SYMPTOMS:

Treatment options may include the following in case symptoms are bothersome or if the patient experiences ulcerations or erosions:

Medicated mouth rinses or sprays:

The size of oral lesions may be decreased by these rinses or sprays, which could also numb or soothe a painful mouth.

Corticosteroids:

The most effective medications for oral lichen planus are high-potency corticosteroid gels or ointments applied to lesions in the mouth. The affected person might also require taking oral corticosteroid pills, since these medications could result in candidiasis or oral thrush, which also need medications. Corticosteroids can be injected to lesions that don’t seem to improve with topical treatments. A doctor should be consulted to consider the possible risks related with long-term corticosteroid use, like suppression of the adrenal gland.

Immunosuppressant medications:

Medications suppressing the immune system might be an alternative in case a person’s oral lichen planus doesn’t improve with corticosteroids. But the person should make certain to understand the positive and negative effects of these medications, because they tend to have serious side effects in addition to some of them being linked to cancer.

 

Managing oral lichen planus could be hard, and the patient might need to try various treatments to find the most effective one. The patient might need to be treated for months if not for years because oral lichen planus is usually chronic.
 

Prognosis:

Not available

Expert's opinion

Expert's Name:
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