Oral Medicine & Pathology

Lichen Planus: Clinical features, Incidence, Etiology, Diagnosis, Management

 

Lichen Planus

 

Clinical features

– Oral lesions tend to be bilateral, mainly in the buccal mucosae.

– White lesions are common; erosions are less common. There may be lesions of
genital mucosa, skin or skin appendages.

– Reticular lesions are most often found on the buccal mucosae, sometimes on the tongue.

– Papular lesions affect similar sites. Plaque-like lesions usually affect the posterior
buccal mucosa.

– Red lesions of atrophic lichen planus (LP) may simulate erythroplasia.

– Lesions may be asymptomatic or cause soreness.

– Erosions are irregular, persistent and painful, with a yellowish slough, and are often
associated with white lesions.

– LP can cause ‘desquamative gingivitis’.

– Lichen planus can have a small premalignant potential (1% ± after 10 years).

– The rash is pruritic, polygonal, purplish and papular, predominantly on flexor surfaces of wrists, and shins.

– Trauma may induce lesions (Koebner phenomenon).

– Alopecia or nail deformities are seen occasionally.

– Genital lesions are typically white or erosive.

Incidence

– Common: mainly middle-aged or elderly females.

– A T-lymphocyte-mediated disorder.

– Usually no aetiological factor is identifiable.

– A minority are due to drugs, such as non-steroidal antiinflammatory drugs
(lichenoid lesions), graftversus- host disease, liver disorders, hepatitis C (possibly)
and reactions to amalgam or gold (possibly).

Diagnosis

– Clinical: drug history; biopsy.

– Differentiate from other causes of white lesions and ulcers, especially discoid
lupus erythematosus and keratoses.

– The ‘desquamative gingivitis’ of lichen planus must be differentiated from that of mucous membrane pemphigoid.

Management

– Asymptomatic: no treatment; reassurance and periodical (1 to 2 times/year) examinations.

– Symptomatic: corticosteroids topically and, rarely, intralesionally or systemically.

– Other drugs, such as retinoids or ciclosporin, have not proved reliably better or may have
adverse effects.

– Tacrolimus may be beneficial.Oral lichen planusOral lichen planusOral lichen planusOral lichen planusOral lichen planusOral lichen planus

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