Lichen Planus

The primary signs and symptoms of oral lichen planus are the lesions affecting 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

​The lesions may appear on the inside of the cheeks, gums, tongue, inner tissues of the lips, the throat or the esophagus.

​The red, inflamed lesions and open sores of oral lichen planus can cause a burning sensation or pain. The white, lacy patches alone usually don’t cause discomfort, except when they appear on the tongue.

​Other signs or symptoms may include:

– A metallic taste or a blunted taste sensation if the tongue is affected
– Dry mouth
– Difficulty swallowing if the throat or esophagus is affected
– Sensitivity to hot or spicy foods
– Bleeding and irritation with tooth brushing

The cause of oral lichen planus is unknown. The lesions that appear are the result of inflammation controlled by specific white blood cells called T lymphocytes. Normally, these cells are active at the site of disease or injury.

Doctors and researchers don’t know what prompts T lymphocytes to be activated in oral lichen planus. However, certain diseases, medical conditions or other factors may act as triggers of the inflammatory disorder in some people.

Oral lichen planus is a chronic condition that can be difficult to manage. The treatment goals are to help severe lesions heal and to lessen 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.

CORTICOSTEROIDS

Corticosteroids may reduce inflammation associated with oral lichen planus. The side effects vary depending on whether it’s used as a mouthwash or ointment applied directly to the mucous membrane (topical), taken as a pill (oral), or administered as an injection. The potential benefit of corticosteroids needs to be balanced with possible side effects, which include the following:

Topical

Topical corticosteroids to treat oral lichen planus may result in oral thrush, an infection caused by the Candida albicans fungus. If this infection occurs, you’ll need to take an antifungal medication. Long-term use of topical corticosteroids may also cause suppression of adrenal gland function and a lessening of the treatment effect.

Oral

Long-term use of oral corticosteroids can cause weakening of the bones (osteoporosis), diabetes, high blood pressure, high cholesterol and other serious side effects.

Injections

Injections may be administered directly into lesions. Repeated use of corticosteroid injections can cause some of the same side effects as oral corticosteroids.

​RETINOIDS

Retinoids are synthetic versions of vitamin A that can be applied as a topical ointment or taken orally. The topical treatment doesn’t cause the same side effects associated with corticosteroids, but it 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.

NON STEROIDAL OINTMENTS

In the past few years, 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. Examples of these topical medications include tacrolimus (Protopic ointment) and pimecrolimus (Elidel cream).

ADDRESSING TRIGGERS

If your doctor suspects that oral lichen planus may be related to a drug you take, hepatitis C infection, an allergen or stress, he or she will recommend steps to address the trigger. These actions may include the following:

Drugs

Your doctor may ask you to stop taking a drug or to try an alternative drug to the one that may be acting as a trigger. This action may require consultation 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.

Allergens

If tests suggest that an allergen may be a potential trigger, you’ll be advised to avoid the allergen, and you may need to see a dermatologist or an allergist for additional treatment. If a dental device is a suspected allergen, you may need to see your dentist to have dental materials extracted and replaced.

Stress

Because stress may be a factor that complicates symptoms or triggers the recurrence of symptoms, you may need to develop skills to avoid or manage stress. Your doctor may refer you to a psychotherapist, psychiatrist or other specialist in mental health care who can help you identify stressors, develop stress management strategies or address other mental health care concerns.