Oral Lichen Planus Treatment & Management
- Author: Philip B Sugerman, MDS, PhD; Chief Editor: William D James, MD more...
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.[28, 29, 30]
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concerns with the current therapies are the local and systemic adverse effects and lesion recurrence after treatment is withdrawn.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.
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 are limited.
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.
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.
Sugerman PB, Satterwhite K, Bigby M. Autocytotoxic T-cell clones in lichen planus. Br J Dermatol. 2000 Mar. 142(3):449-56. [Medline].
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].
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].
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].
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].
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].
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].
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].
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].
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].
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].
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.
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].
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].
Dereure O, Basset-Seguin N, Guilhou JJ. Erosive lichen planus: dramatic response to thalidomide. Arch Dermatol. 1996 Nov. 132(11):1392-3. [Medline].
Camisa C, Popovsky JL. Effective treatment of oral erosive lichen planus with thalidomide. Arch Dermatol. 2000 Dec. 136(12):1442-3. [Medline].
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].
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].
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].
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].
Sugerman PB, Savage NW, Zhou X, Walsh LJ, Bigby M. Oral lichen planus. Clin Dermatol. 2000 Sep-Oct. 18(5):533-9. [Medline].
Axéll T, Rundquist L. Oral lichen planus--a demographic study. Community Dent Oral Epidemiol. 1987 Feb. 15(1):52-6. [Medline].
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].
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].
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].
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].
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].
Chan ES, Thornhill M, Zakrzewska J. Interventions for treating oral lichen planus. Cochrane Database Syst Rev. 2000. CD001168. [Medline].
Eisen D. The therapy of oral lichen planus. Crit Rev Oral Biol Med. 1993. 4(2):141-58. [Medline].
McCartan B, McCreary C. What is the rationale for treating oral lichen planus?. Oral Dis. 1999 Jul. 5(3):181-2. [Medline].
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].
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].
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].
Eisenberg E. Oral lichen planus: a benign lesion. J Oral Maxillofac Surg. 2000 Nov. 58(11):1278-85. [Medline].
Silverman S Jr. Oral lichen planus: a potentially premalignant lesion. J Oral Maxillofac Surg. 2000 Nov. 58(11):1286-8. [Medline].
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].
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].
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].