Oral lichen planus (LIE-kun PLAY-nus) is an ongoing (chronic) inflammatory condition that affects mucous membranes inside your mouth. Oral lichen planus may appear as white, lacy patches; red, swollen tissues; or open sores. These lesions may cause burning, pain or other discomfort.
Oral lichen planus can't be passed from one person to another. The disorder occurs when the immune system mounts an attack against cells of the oral mucous membranes for unknown reasons (autoimmune disorder).
Symptoms can usually be managed, but people who have oral lichen planus need regular monitoring because they may be at risk of developing mouth cancer in the affected areas.
Signs and symptoms of oral lichen planus affect the mucous membranes of the mouth.
The lesions may appear as:
- Lacy, white, raised patches of tissues
- Red, swollen, tender patches of tissues
- Open sores
These lesions may appear on the:
- Inside of the cheeks, the most common location
- Inner tissues of the lips
Pain or discomfort
The red, inflamed lesions and open sores of oral lichen planus can cause a burning sensation or pain. The white, lacy patches may not cause discomfort when they appear on the inside of the cheeks but may be painful when they involve the tongue.
Other signs or symptoms
Other signs or symptoms may include:
- Change in taste or a blunted taste sensation if the tongue is affected
- Sensitivity to hot or spicy foods
- Bleeding and irritation with tooth brushing
- Inflammation of the gums (gingivitis)
Other types of lichen planus
If you have oral lichen planus, you may have lichen planus lesions affecting other parts of your body.
- Skin. Lesions usually appear as purplish, flat-topped bumps that are often itchy.
- Genitals. Lesions on the female genitalia often cause pain or burning and discomfort with intercourse. The lesions are usually red and eroded and occasionally appear as white areas. This can lead to scarring and loss of normal vaginal function and an inability to have intercourse.
- Ears. Lichen planus of the ears can lead to hearing loss.
- Scalp. When skin lesions appear on the scalp — a rare condition — they may cause temporary or permanent hair loss.
- Nails. Lichen planus of the toenails or fingernails, also rare, may result in ridges on the nails, thinning or splitting of nails, and temporary or permanent nail loss.
- Eyes. Rarely, lichen planus may involve the mucous membrane surfaces of the eyes, and can cause a loss of tear duct function and scarring of the eyelids.
- Esophagus. Lichen planus of the esophagus also is rare, but when it occurs, it may result in a narrowing of the esophagus or the formation of tightened, ring-like bands in the esophagus that can make swallowing difficult.
When to see a doctor
See your doctor or dentist if you:
- Notice sores inside your mouth that don't heal
- Have white or red patches in your mouth
- Have mouth pain
- Have repeated bleeding in your mouth when brushing or flossing
- Notice any change in the way your mouth looks and feels
- Have lesions or sores on your skin, genitals, scalp or nails
- Develop unexplained scarring of the transparent membrane (conjunctiva) that covers the white part of your eyeball
- Develop ear canal inflammation (otitis) that does not respond to treatment or does not have an apparent diagnosis or cause
The cause of oral lichen planus is unknown. T lymphocytes — certain white blood cells involved in inflammation — are normally active at the site of disease or injury and cause the lesions. Doctors and researchers don't know what prompts T lymphocytes to be activated in oral lichen planus. However, in some people, certain factors, such as those below, may trigger an inflammatory disorder.
- Hepatitis C infection and other types of liver disease
- Hepatitis B vaccine
- Allergy-causing agents (allergens), such as foods, dental materials or other substances
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve, others)
- Certain medications for heart disease, high blood pressure or arthritis
Some factors can increase the likelihood of developing oral lichen planus.
- Middle-aged women are most often affected, although anyone can develop oral lichen planus.
- Having a disorder that compromises your immune system may increase your risk of developing oral lichen planus.
- Genes may play a role in the development of oral lichen planus.
Factors that may complicate the condition or worsen symptoms include:
- Tobacco products
- Rough dental work
- Poorly fitting dentures
- Poor oral habits, such as biting the lip or cheeks
- Buildup of dental plaque or tartar
In addition, oral lichen planus may increase the risk of oral cancers, particularly a type known as squamous cell carcinoma. To help prevent cancer, take these actions:
- Get oral cancer screenings annually or as directed by your doctor.
- If you drink alcohol, do so in moderation. Talk to your doctor to see if you should avoid alcohol completely.
- If you use any tobacco products, quit. Talk to your doctor if you need help ending a tobacco habit.
You'll likely start by seeing your primary doctor or dentist. Depending on your symptoms, you may be referred to a specialist in skin diseases (dermatologist), a specialist in gum and dental diseases (periodontist), a specialist of the upper gastrointestinal tract (gastroenterologist), or a doctor specializing in women's health (gynecologist).
What you can do
To get ready for your appointment:
- Bring a copy of all previous consultations and tests you've had about this problem.
- Ask if there's anything you need to do before the appointment, such as restrict your diet.
- Make a list of any symptoms you're experiencing, including any that may seem unrelated to your sore mouth.
- Make a list of key personal information, including any major stresses or recent life changes.
- Make a list of all medications, vitamins, herbs or supplements that you're taking.
- Prepare questions ahead of time to help make the most of your time with your doctor or dentist.
- Take a family member or friend with you, if possible, for support and to help you remember everything.
Some basic questions to ask your doctor or dentist include:
- What is likely causing my symptoms or condition?
- What are other possible causes?
- What kinds of tests do I need?
- What is the best course of action?
- What are the alternatives to the primary approach that you're suggesting?
- I have these other health conditions. How can I best manage them together?
- Are there any restrictions that I need to follow?
- Should I see a specialist?
- Is there a generic alternative to the medicine you're prescribing?
- Are there any brochures or other printed material that I can have? What websites do you recommend?
Don't hesitate to ask questions anytime you don't understand something.
What to expect from your doctor
Your doctor or dentist is likely to ask you a number of questions. Be ready to answer them so you can focus on points you want to spend more time on. Your doctor or dentist may ask:
- When did the lesions or sores appear in your mouth?
- Have you found lesions anywhere else on your body?
- Do you feel any pain, burning sensations or other discomfort in your mouth?
- How would you describe the severity of the pain or discomfort — mild, moderate or severe?
- Have you recently started new medications?
- Have you recently had vaccinations?
- Do you take supplements or vitamins or other nonprescription herbs or medicines?
- Do you have any allergies?
- Have you experienced any new or unusual stresses in your life?
- What other health conditions do you have?
Your doctor or dermatologist makes a diagnosis of oral lichen planus based on your symptoms, a careful examination of the abnormalities in your mouth and, if necessary, the results of lab tests. These tests may include:
- Biopsy. Your doctor may take a small tissue sample from one or more lesions in your mouth. The tissue is examined under a microscope to identify a typical pattern of T lymphocytes consistent with a diagnosis of oral lichen planus. Other more specialized microscopic tests may be needed to identify profiles of immune system proteins commonly associated with the disorder.
- Cultures. Using a cotton swab to take a sample of cells from your mouth and then examining the sample under a microscope can reveal whether you have a secondary fungal, bacterial or viral infection.
- Blood tests. These may be done to rule out conditions such as hepatitis C, which may rarely be associated with oral lichen planus, and lupus, which may look similar to oral lichen planus.
- Allergy tests. Your doctor may refer you to an allergy specialist (allergist) or dermatologist for skin patch testing to identify agents to which you may be allergic and that may act as triggers for your condition.
Oral lichen planus is a chronic condition, so the treatment goals focus on helping severe lesions heal and reducing pain or other discomfort. Your doctor will monitor your condition to increase or decrease dosages, change medications or stop treatment as necessary.
If you have no pain or discomfort and if only white, lacy lesions are present, you may not need any treatment. For more severe symptoms, you may need one or more of the options below.
Treatments such as topical numbing agents can be used to provide temporary relief for areas that are particularly painful.
Corticosteroids may reduce inflammation related to oral lichen planus. Side effects vary, depending on whether corticosteroids are used as a mouthwash, ointment or gel applied directly to the mucous membrane (topical), given as an injection directly into the lesion, or taken as a pill (oral). Topical is the preferred method for corticosteroid use with oral lichen planus. Talk with your doctor to weigh the potential benefits against possible side effects.
Retinoids are synthetic versions of vitamin A that can be applied as a topical ointment or taken orally, but they're not commonly used to treat oral lichen planus. Topical treatment may irritate the mucous membranes of your mouth.
Because both topical and oral retinoids can cause birth defects, the drug shouldn't be used by women who are pregnant or planning to become pregnant in the near future. Your doctor can advise you on necessary precautions.
Immune response medicines
Medications that suppress or modify your body's immune response may be used as ointments, gels or oral medication. Treatments that suppress immune system abnormalities may improve more severe lesions and lessen pain.
For example, several reports have shown the effectiveness of topical medications, called calcineurin inhibitors, which are closely related to or identical to oral medications used to prevent rejection of transplanted organs. These treatments appear to be effective for the treatment of oral lichen planus. However, packaging for these medications carries a Food and Drug Administration (FDA) warning because of an unclear association with cancer. Examples of these topical medications include tacrolimus (Protopic) and pimecrolimus (Elidel).
For severe cases where oral lichen planus also involves other areas — such as the scalp, genitalia or esophagus — systemic medications that suppress the immune system may be used. However, these are seldom used for oral lichen planus unless other parts of the body also are affected.
Dealing with triggers
If your doctor suspects that oral lichen planus may be related to a drug you take, or to a hepatitis C infection, an allergen or stress, he or she will recommend how to address the trigger. These actions may include:
- Drugs. Your doctor may ask you to stop taking a drug that can be a trigger or to try another drug instead. This may require discussion with the doctor who originally prescribed your medication.
- Hepatitis C. You'll likely be referred to a specialist in infectious diseases or a specialist in liver disease (hepatologist) for further diagnostic evaluation and disease management.
- Allergen. If tests suggest that an allergen may be a potential trigger, you'll be advised to avoid the allergen. You may need to see a dermatologist or an allergist for additional testing, such as allergy skin patch testing. If a dental device is a suspected allergen, you may need to see your dentist to have dental materials removed and replaced.
- Limiting oral trauma. Performing gentle oral cleaning and choosing foods that are soft may help limit the discomfort associated with oral lichen planus.
- Stress. Because stress may complicate symptoms or trigger symptom recurrence, you may need to develop skills to avoid or manage stress. Your doctor may refer you to a mental health specialist who can help you identify stressors, develop stress management strategies or address other mental health concerns.
In addition to regular medical and dental treatment, self-care measures may help improve your oral lichen planus symptoms or help prevent recurring episodes of severe symptoms. These include:
- Practicing good oral hygiene. Keep your mouth clean to reduce your symptoms and help prevent infection. Gently brush your teeth at least twice a day and floss daily. See your dentist twice a year for checkups and cleanings, or more often as directed by your dentist.
- Adjust your diet. Cut out spicy or acidic foods if they seem to trigger or worsen your symptoms. And reduce or eliminate the use of caffeine, alcohol or tobacco.
March 08, 2013
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