Lichen Planus

Oral lichen planus (LP) is a common, chronic inflammatory condition of unknown etiology, which affects 1-2% of adults. Current evidence suggests an immune-mediated mechanism. All age groups may be affected, but adults over 40 years of age predominate with a female-to-male ratio of 1.4:1.

Often referred to as thrush, it is the most common form and may present with a burning sensation.

Reticular LP

  • Appears as white lacy striations or papules bilaterally on the posterior buccal mucosa.
  • Other sites, such as the tongue or gingiva, may be involved.
  • It is often readily identified clinically.

General LP Symptoms

  • Symptoms tend to wax and wane over years.
  • Up to two-thirds of patients complain of some sensitivity, especially with erythematous and erosive forms.
  • Up to 44% of patients develop extraoral lesions on the flexor surfaces of the extremities, scalp, and nails.
  • Up to 25% of women may have genital involvement. Incidence among men is much lower.

Other forms of Oral LP*

  • Plaque-like white lesions
  • Erythematous or atrophic
  • Erosive
  • Bullous
  • Lesions may exhibit mixed types often with zones of tender erythema and painful ulcers, surrounded by peripheral white, radiating striae.
  • May present with generalized erythema and ulceration of the gingiva known as desquamative gingivitis.

Reticular Lichen Planus

Brad Neville, DDS
Brad Neville, DDS

Erosive Lichen Planus

Brad Neville, DDS
Brad Neville, DDS

Treatment

  • Asymptomatic patients do not require treatment.
  • For symptomatic patients, topical corticosteroid gels or mouth rinses are helpful.
  • Lesions not exhibiting classic features may require biopsy for diagnosis.

* Note that extra-oral Lichen Planus has a very different appearance described as purple, polygonal, pruritic (itchy), planar (flat-topped), papules, and plaques.

References

Gonsalves WC, Chi AC, Neville BW, Common Oral Lesions: Part I. Superficial Mucosal Lesions, AFP 2007;75:501-507.

Pappas PG, Kauffman CA, Andes D, et al. Clinical Practice Guidelines for the Management Candidiasis: 2009 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases. 48(5): 503-535.