Oral Lichen Planus Treatment & Management

  • Author: Philip B Sugerman, MDS, PhD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Oct 29, 2010
 

Medical Care

Medical treatment of oral lichen planus (OLP) is essential for the management of painful, erythematous, erosive, or bullous lesions. The principal aims of current oral lichen planus therapy are the resolution of painful symptoms, the resolution of oral mucosal lesions, the reduction of the risk of oral cancer, and the maintenance of good oral hygiene. In patients with recurrent painful disease, another goal is the prolongation of their symptom-free intervals.[30, 31, 32]

The main concerns with the current therapies are the local and systemic adverse effects and lesion recurrence after treatment is withdrawn. No treatment of oral lichen planus is curative.

Eliminate local exacerbating factors. Treat any sharp teeth or broken restorations or prostheses that are likely to cause physical trauma to areas of erythema or erosion by using conventional dental means. Scale the teeth to remove calculous deposits and reduce sharp edges. If the patient has an isolated plaquelike or erosive oral lichen planus lesion on the buccal or labial mucosa adjacent to a dental restoration, and if an allergy is detected by means of skin patch testing, the lesion may heal if the offending material is removed or replaced. (However, most lichenoid lesions adjacent to dental restorations are asymptomatic.)

If systemic drug therapy (eg, treatment with NSAIDs, antimalarials, or beta-blockers) is suspected as the cause of oral lichenoid lesions, changing to another drug may be worthwhile. This change must be undertaken only by the patient's attending physician. However, the switch rarely resolves the erosions, and almost never resolves the white patches of oral lichen planus.

Inform all patients with oral lichen planus about their slightly increased risk of oral SCC (the most common of all oral malignancies). As with all patients, advise those with oral lichen planus that this risk may be reduced by eliminating tobacco and alcohol consumption and by consuming a diet rich in fresh fruits and vegetables, among other measures (see Complications). Erosive and atrophic lesions can be converted into reticular lesions by using topical steroids. Therefore, the elimination of mucosal erythema and ulceration, with a residual asymptomatic reticular or papular lesions, may be considered an end point of current oral lichen planus therapy. With respect to plaque lesions, the effect of treatment on the risk of oral cancer is unclear.

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Consultations

A specialist in oral pathology or a dermatologist typically makes the primary diagnosis of oral lichen planus. Opinions may be sought from the following specialists if patients have relevant signs or symptoms:

  • Dermatologist - For the diagnosis, treatment, and review of skin, nail, genital, and scalp lesions
  • Otolaryngologist - For the diagnosis, treatment, and review of laryngeal and esophageal lesions
  • Ophthalmologist - For the diagnosis, treatment, and review of conjunctival lesions
  • Gynecologist - For the diagnosis, treatment, and review of vulval and vaginal lesions

Because exacerbations of oral lichen planus have been linked to periods of stress and anxiety, a psychological assessment might or might not be beneficial in some patients with oral lichen planus. However, objective data to support this link is limited.

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Diet

Patients with oral lichen planus have a slightly increased risk of oral SCC, although the precise risk of oral cancer in patients with oral lichen planus is unknown. Advise patients with oral lichen planus that a diet rich in fresh fruit and vegetables may help reduce the risk of oral SCC.

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Activity

Advise patients with oral lichen planus to do the following:

  • Eliminate smoking and alcohol consumption.
  • Eat a nutritious diet, including fresh fruit and vegetables, because this may help reduce the risk of oral cancer.
  • Pay attention when symptoms are exacerbated or when lesions change.
  • Be aware of the need for regular re-examination and repeat lesion biopsy, especially if clinical changes in the lesion occur.

Although oral lichen planus does not increase the risk of dental caries or gingival disease, painful oral lichen planus lesions (particularly those on the gums) can limit the patient's ability to maintain good oral hygiene. Therefore, advise all patients with oral lichen planus of the appropriate methods of oral hygiene and to see their dentists often.

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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 and International Association for Dental Research

Disclosure: Abbott Labs Salary Employment

Coauthor(s)

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

Disclosure: Nothing to disclose.

Specialty Editor Board

Gregory J Raugi, MD, PhD  Professor, Department of Internal Medicine, Division of Dermatology, University of Washington at Seattle; 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.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center

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

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

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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.
 
 
 
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