Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Oral Lichen Planus Follow-up

  • Author: Philip B Sugerman, MDS, PhD; Chief Editor: William D James, MD  more...
 
Updated: Sep 21, 2015
 

Further Outpatient Care

Re-examine patients with oral lichen planus (OLP) during active treatment, and monitor lesions for reduction in mucosal erythema and ulceration and alleviation of symptoms. Continue active treatment and try alternative therapies until erythema, ulceration, and symptoms are controlled. Follow up with patients with oral lichen planus at least every 6 months.

Advise patients with oral lichen planus to pay attention to when symptoms are exacerbated or when lesions change. Such changes generally indicate a phase of increased erythematous or erosive disease.

In view of the potential association of oral lichen planus with oral SCC, an appropriate specialist should follow up with the patients every 6-12 months. In addition, advise patients to regularly examine their mouths and seek the help of a specialist if persistent red or ulcerative oral mucosal lesions develop.

Candidal cultures or smears may be obtained periodically. Infections can be controlled with topical antimycotic preparations. These tests may be of limited clinical value because oral C albicans is present in at least 70% of all healthy persons.

Next

Deterrence/Prevention

Patients with oral lichen planus may have a slightly increased risk of oral cancer, although the precise risk is unknown.

The risk of oral cancer in patients with oral lichen planus may be reduced by means of the following:

  • Elimination of smoking and alcohol consumption
  • Effective treatment of atrophic, erosive, and plaque oral lichen planus lesions
  • Consumption of a nutritious diet including fresh fruit and vegetables
  • Elimination of C albicans superinfection
  • Clinical examination with any exacerbation of symptoms or change in lesion presentation
  • Regular clinical examination and repeat biopsy as required. Oral brush biopsy can be used to limit the number of scalpel biopsies (see Oral Brush Biopsy with Computer-Assisted Analysis). The frequency of brush biopsy for oral lichen planus patient follow-up has not been established. However, if the clinical features of the lesions change, scalpel biopsy should be repeated.
Previous
Next

Complications

Oral lichen planus and its treatment may predispose people to oral C albicans superinfection.

Patients with oral lichen planus may have a slightly increased risk of oral cancer, which they may be able to reduce (see Deterrence/Prevention).

Oral SCC in patients with oral lichen planus is a feared complication and a controversial issue. In retrospective studies, less than 5% of patients with oral lichen planus who were not using tobacco products developed oral SCC.[33, 34, 35] Atrophic, erosive, and plaque lesions may be at greater risk of malignant change, although SCC may arise in the unaffected oral mucosa as well. The most important risk factors of oral SCC remain the concomitant use of alcohol and tobacco products. Any additive effect of oral lichen planus is difficult to detect in patients who use both.[36]

Proposed reasons for the increased risk of oral SCC in patients with oral lichen planus include the following:

  • Compared with healthy mucosa, the oral mucosa affected by oral lichen planus may be more sensitive to C albicans and to the exogenous mutagens found in tobacco, alcohol, and betel quid.
  • In patients with oral lichen planus, the chronic inflammatory response and the simultaneous healing response of epithelial wounds may increase the likelihood of cancer-forming gene mutations. 
Previous
Next

Prognosis

Oral lichen planus is a chronic inflammatory disease. The lesions of cutaneous lichen planus typically resolve within 1-2 years, whereas the lesions of oral lichen planus are long lasting and persist for 20 years or longer. Resolution of the white striations, plaques, or papules is rare. Symptomatic oral lichen planus (ie, atrophic or erosive disease) characteristically waxes and wanes, although the associated white patches do not resolve. Patients with atrophic (erythematous) or erosive (ulcerative) disease commonly have significant local morbidity. Oral lichen planus can have a significant negative impact on quality of life.[37]

Current immunosuppressive therapies usually control oral mucosal erythema, ulceration, and symptoms in patients with oral lichen planus with minimal adverse effects. However, a range of therapies may need to be tried.

Advise patients that oral lichen planus lesions may persist for many years with periods of exacerbation and quiescence.

Follow up patients with oral lichen planus at least every 6 months for clinical examination and repeat biopsy as required, although patients should be advised to seek medical care whenever the symptoms are exacerbated or the presentation of the lesions change.

In the context of appropriate medical care, the prognosis for most patients with oral lichen planus is excellent.

Previous
Next

Patient Education

Patient education is important. Many patients with oral lichen planus are concerned about the possibilities of its malignancy and contagiousness. Many patients are frustrated by the lack of available patient education concerning oral lichen planus.[38]

Inform patients with oral lichen planus of the following:

  • The chronicity of oral lichen planus and the expected periods of exacerbation and quiescence
  • The aims of treatment, specifically the elimination of mucosal erythema, ulceration, pain, and sensitivity
  • The lack of large randomized controlled therapeutic clinical trials
  • The possibility that several treatments may need to be tried
  • The potentially increased risk of oral cancer
  • The possibility of reducing the risk of oral cancer (see Complications)

Information about oral lichen planus is currently available online. For instance, an oral lichen planus chat room is available at the homepage of the International Lichen Planus Support Group Web.

For patient education material, visit eMedicineHealth's Cancer Center, as well as Cancer of the Mouth and Throat.

Previous
 
Contributor Information and Disclosures
Author

Philip B Sugerman, MDS, PhD Senior Clinical Science Manager, Abbott Immunology, Abbott Laboratories

Philip B Sugerman, MDS, PhD is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology, International Association for Dental Research

Disclosure: Nothing to disclose.

Coauthor(s)

Stephen R Porter, MD, PhD FDS RCS, FDS RSE, Professor of Oral Medicine, University College London; Academic Head, Director of Research Strategy, Oral Medicine/Special Needs Unit, Division of Maxillofacial Diagnostic, Medical and Surgical Sciences, Eastman Dental Institute for Oral Health Sciences

Stephen R Porter, MD, PhD is a member of the following medical societies: British Association of Oral and Maxillofacial Surgeons, Royal College of Surgeons of England, Royal Society of Medicine, Royal College of Surgeons of Edinburgh

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Drore Eisen, MD, DDS Consulting Staff, Department of Dermatology, Dermatology Research Associates of Cincinnati

Drore Eisen, MD, DDS is a member of the following medical societies: American Academy of Dermatology, American Academy of Oral Medicine, American Dental Association

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Gregory J Raugi, MD, PhD Professor, Department of Internal Medicine, Division of Dermatology, University of Washington at Seattle School of Medicine; Chief, Dermatology Section, Primary and Specialty Care Service, Veterans Administration Medical Center of Seattle

Gregory J Raugi, MD, PhD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References
  1. Sugerman PB, Satterwhite K, Bigby M. Autocytotoxic T-cell clones in lichen planus. Br J Dermatol. 2000 Mar. 142(3):449-56. [Medline].

  2. Sugerman PB, Savage NW, Walsh LJ, et al. The pathogenesis of oral lichen planus. Crit Rev Oral Biol Med. 2002. 13(4):350-65. [Medline].

  3. Shan J, Ma JM, Wang R, Liu QL, Fan Y. Proliferation and Apoptosis of Peripheral Blood Mononuclear Cells in Patients with Oral Lichen Planus. Inflammation. 2012 Nov 8. [Medline].

  4. Younes F, Quartey EL, Kiguwa S, Partridge M. Expression of TNF and the 55-kDa TNF receptor in epidermis, oral mucosa, lichen planus and squamous cell carcinoma. Oral Dis. 1996 Mar. 2(1):25-31. [Medline].

  5. Sklavounou A, Chrysomali E, Scorilas A, Karameris A. TNF-alpha expression and apoptosis-regulating proteins in oral lichen planus: a comparative immunohistochemical evaluation. J Oral Pathol Med. 2000 Sep. 29(8):370-5. [Medline].

  6. Khan A, Farah CS, Savage NW, Walsh LJ, Harbrow DJ, Sugerman PB. Th1 cytokines in oral lichen planus. J Oral Pathol Med. 2003 Feb. 32(2):77-83. [Medline].

  7. Thongprasom K, Dhanuthai K, Sarideechaigul W, Chaiyarit P, Chaimusig M. Expression of TNF-alpha in oral lichen planus treated with fluocinolone acetonide 0.1%. J Oral Pathol Med. 2006 Mar. 35(3):161-6. [Medline].

  8. Simon M Jr, Gruschwitz MS. In situ expression and serum levels of tumour necrosis factor alpha receptors in patients with lichen planus. Acta Derm Venereol. 1997 May. 77(3):191-3. [Medline].

  9. Simark-Mattsson C, Bergenholtz G, Jontell M, et al. Distribution of interleukin-2, -4, -10, tumour necrosis factor-alpha and transforming growth factor-beta mRNAs in oral lichen planus. Arch Oral Biol. 1999 Jun. 44(6):499-507. [Medline].

  10. Karagouni EE, Dotsika EN, Sklavounou A. Alteration in peripheral blood mononuclear cell function and serum cytokines in oral lichen planus. J Oral Pathol Med. 1994 Jan. 23(1):28-35. [Medline].

  11. Sugermann PB, Savage NW, Seymour GJ, Walsh LJ. Is there a role for tumor necrosis factor-alpha (TNF-alpha) in oral lichen planus?. J Oral Pathol Med. 1996 May. 25(5):219-24. [Medline].

  12. Sklavounou A, et al. Elevated serum levels of the apoptosis related molecules TNF-alpha, Fas/Apo-1 and Bcl-2 in oral lichen planus. J Oral Pathol Med. 2004. 33:386-390.

  13. Rhodus NL, Cheng B, Myers S, Bowles W, Ho V, Ondrey F. A comparison of the pro-inflammatory, NF-kappaB-dependent cytokines: TNF-alpha, IL-1-alpha, IL-6, and IL-8 in different oral fluids from oral lichen planus patients. Clin Immunol. 2005 Mar. 114(3):278-83. [Medline].

  14. Carrozzo M, Uboldi de Capei M, Dametto E, et al. Tumor necrosis factor-alpha and interferon-gamma polymorphisms contribute to susceptibility to oral lichen planus. J Invest Dermatol. 2004 Jan. 122(1):87-94. [Medline].

  15. Dereure O, Basset-Seguin N, Guilhou JJ. Erosive lichen planus: dramatic response to thalidomide. Arch Dermatol. 1996 Nov. 132(11):1392-3. [Medline].

  16. Camisa C, Popovsky JL. Effective treatment of oral erosive lichen planus with thalidomide. Arch Dermatol. 2000 Dec. 136(12):1442-3. [Medline].

  17. Sampaio EP, Sarno EN, Galilly R, Cohn ZA, Kaplan G. Thalidomide selectively inhibits tumor necrosis factor alpha production by stimulated human monocytes. J Exp Med. 1991 Mar 1. 173(3):699-703. [Medline].

  18. Moreira AL, Sampaio EP, Zmuidzinas A, Frindt P, Smith KA, Kaplan G. Thalidomide exerts its inhibitory action on tumor necrosis factor alpha by enhancing mRNA degradation. J Exp Med. 1993 Jun 1. 177(6):1675-80. [Medline].

  19. Porter SR, Kirby A, Olsen I, Barrett W. Immunologic aspects of dermal and oral lichen planus: a review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997 Mar. 83(3):358-66. [Medline].

  20. Scully C, Beyli M, Ferreiro MC, et al. Update on oral lichen planus: etiopathogenesis and management. Crit Rev Oral Biol Med. 1998. 9(1):86-122. [Medline].

  21. Sugerman PB, Savage NW, Zhou X, Walsh LJ, Bigby M. Oral lichen planus. Clin Dermatol. 2000 Sep-Oct. 18(5):533-9. [Medline].

  22. Axéll T, Rundquist L. Oral lichen planus--a demographic study. Community Dent Oral Epidemiol. 1987 Feb. 15(1):52-6. [Medline].

  23. Eisen D. The evaluation of cutaneous, genital, scalp, nail, esophageal, and ocular involvement in patients with oral lichen planus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999 Oct. 88(4):431-6. [Medline].

  24. Koch P, Bahmer FA. Oral lesions and symptoms related to metals used in dental restorations: a clinical, allergological, and histologic study. J Am Acad Dermatol. 1999 Sep. 41(3 Pt 1):422-30. [Medline].

  25. Pendyala G, Joshi S, Kalburge J, Joshi M, Tejnani A. Oral Lichen Planus: A Report and Review of an Autoimmune-Mediated Condition in Gingiva. Compend Contin Educ Dent. 2012 Sep. 33(8):e102-e108. [Medline].

  26. Lodi G, Porter SR, Scully C. Hepatitis C virus infection: Review and implications for the dentist. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998 Jul. 86(1):8-22. [Medline].

  27. Lodi G, Scully C, Carrozzo M, Griffiths M, Sugerman PB, Thongprasom K. Current controversies in oral lichen planus: report of an international consensus meeting. Part 1. Viral infections and etiopathogenesis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005 Jul. 100(1):40-51. [Medline].

  28. Chan ES, Thornhill M, Zakrzewska J. Interventions for treating oral lichen planus. Cochrane Database Syst Rev. 2000. CD001168. [Medline].

  29. Eisen D. The therapy of oral lichen planus. Crit Rev Oral Biol Med. 1993. 4(2):141-58. [Medline].

  30. McCartan B, McCreary C. What is the rationale for treating oral lichen planus?. Oral Dis. 1999 Jul. 5(3):181-2. [Medline].

  31. Sandhu SV, Sandhu JS, Bansal H, Dua V. Oral lichen planus and stress: An appraisal. Contemp Clin Dent. 2014 Jul. 5(3):352-6. [Medline].

  32. Shilpa PS, Kaul R, Bhat S, Sanjay CJ, Sultana N. Topical tacrolimus in the management of oral lichen planus: literature review. J Calif Dent Assoc. 2014 Mar. 42(3):165-70. [Medline].

  33. Eisen D. The clinical features, malignant potential, and systemic associations of oral lichen planus: a study of 723 patients. J Am Acad Dermatol. 2002 Feb. 46(2):207-14. [Medline].

  34. Eisenberg E. Oral lichen planus: a benign lesion. J Oral Maxillofac Surg. 2000 Nov. 58(11):1278-85. [Medline].

  35. Silverman S Jr. Oral lichen planus: a potentially premalignant lesion. J Oral Maxillofac Surg. 2000 Nov. 58(11):1286-8. [Medline].

  36. Bardellini E, Amadori F, Flocchini P, Bonadeo S, Majorana A. Clinicopathological features and malignant transformation of oral lichen planus: A 12-years retrospective study. Acta Odontol Scand. 2012 Nov 2. [Medline].

  37. Lopez-Jornet P, Camacho-Alonso F. Quality of life in patients with oral lichen planus. J Eval Clin Pract. 2010 Feb. 16(1):111-3. [Medline].

  38. Burkhart NW, Burkes EJ, Burker EJ. Meeting the educational needs of patients with oral lichen planus. Gen Dent. 1997 Mar-Apr. 45(2):126-32; quiz 143-4. [Medline].

 
Previous
Next
 
Plaquelike oral lichen planus on the buccal mucosa on the left side.
Reticular oral lichen planus on the buccal mucosa on the left side.
Ulcerative oral lichen planus on the dorsum of the tongue.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.