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Lichen Planus

Mouth Lesions That Are Usually Benign

A Consultation with Dr. Sarah Fitzpatrick

Dear Doctor,
My dentist recently pointed out a condition in my mouth called “lichen planus.” Can you tell me more about it?

Lichen planus.

Dear Roger,
Lichen planus is a fairly uncommon, non-contagious disease that can appear on skin surfaces and mucus (lining) membranes in various parts of the body: on the wrists, legs, inner (mouth) side of the cheeks, gums, or tongue, for example. It can also involve the genital area or the fingernails.

The disease gets its name from the appearance of the lesions, which were originally thought to look similar to organisms called lichens often found on trees or rocks. (It is not actually related to lichens, which are communities of algae and fungi.) When it affects the skin surfaces, it often shows up as purple-tinted bumps or rash-like discolorations, which may feel rough, itchy or tender. When mucus membranes like the mouth or tongue are affected, a lacy pattern of white lines or ulceration is the typical presentation.

Most people affected by oral lichen planus are unaware of the condition. While lichen planus can produce unsightly and itchy lumps on the skin, in the mouth it’s often overlooked. It may occasionally result in increased sensitivity when consuming spicy or acidic foods, but rarely causes much pain except in severe cases.

Although oral lichen planus most commonly affects the insides of the cheeks and sides of the tongue symmetrically with white net-like lacy lines or ulcerations, the appearance may vary depending on the location in the mouth. If it affects the gums, the areas often appear red and inflamed and may feel sore when brushing and eating. These are among the signs that would lead a dentist to suspect lichen planus, or a lichenoid (lichen planus-like) reaction. The clinical diagnosis can be confirmed by biopsy — that is, taking a small tissue sample and examining it under a microscope in a pathology laboratory. However, oral lichen planus may appear similar microscopically to other medical conditions so it is important to provide a complete health history to your dentist.

Lichen planus is slightly more common in women than in men, and is more often diagnosed in middle aged and older people. It is thought to be a type of autoimmune disease (“auto” – self; “immune” – defense), in which the body reacts to some of its own cells as if they were foreign. It has also been observed that certain medications (and in rare cases, metal fillings) may cause a lichenoid reaction. In addition, the Hepatitis-C virus has also been linked to a lichen planus-like rash in some cases, though no definite association has been proven.

At the present time, there is no cure for this condition; however, in the majority of people, it rarely creates serious problems and in time it may go away on its own. If no symptoms are present, oral lichen planus does not require treatment. If the symptoms are bothersome, however, your dentist or doctor can recommend a number of strategies to ease the discomfort.

How To Manage the Condition

Management often begins with making sure your oral hygiene is as good as it can be. That means gently brushing, with a soft toothbrush — particularly if the gums are affected — and flossing every day. People who are symptomatic can try avoiding foods and beverages that tend to worsen the condition: spicy or acidic foods like citrus fruits, tomatoes, hot peppers, and caffeinated drinks. Limiting stress may help to reduce flare-ups. If more help is needed, a topical steroid may be prescribed to relieve symptoms.

While it’s important to note that this condition is not a type of cancer, in a small number of cases (perhaps one to three percent) oral cancer has been reported to develop over time. It is unknown whether, in those cases, the lichen planus itself transforms into cancer, or if some early instances of oral cancer are instead initially mistaken for lichen planus. This is possible because some oral pre-cancerous lesions have been shown to mimic lichen planus both clinically and microscopically. That’s one reason why regular monitoring and follow-up is recommended with periodic screenings for oral cancer (a good idea for all patients, even those without oral lichen planus). Ceasing all use of tobacco and alcohol is also helpful, as these are preventable risk factors for oral cancer development.

The vast majority of those who develop oral lichen planus will never know they have it, or at most experience some minor discomfort. The most important step to take is to make sure you keep going for regular checkups to ensure proper management of this condition and maintain the best oral health possible.