Oral Lichen Planus Follow-up
- Author: Philip B Sugerman, MDS, PhD; Chief Editor: William D James, MD more...
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.
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.
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.
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.
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.
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.
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.
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.
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