Comprehensive Guide to Oral Lichen Planus: Symptoms, Causes and Treatment Solutions

Lichen planus is a chronic disease that affects your mouth and you might have symptoms like white patches, redness, and swelling.

Lichen planus is a disease that affects the skin and any lining of mucosa. It could be the oral, vaginal, or esophageal mucosa and also the skin, scalp, and nails. ⁽¹⁾ Oral lichen planus (OLP) is one of the forms of lichen planus that affects your mouth. ⁽²⁾ Oral lichen planus causes white lesions to appear in the mouth, often on the insides of the cheeks. This is usually caused by an infection, certain medicines, or some other health conditions.

Oral lichen planus is not contagious, but anyone can get it. It is more common in women than men and in the case of people older than forty. However, although it is rare, kids and young adults can also get it. ⁽³⁾. Oral lichen planus affects all racial groups. ⁽⁴⁾

People getting oral lichen planus experience white patches, swollen tissues, and open sores. Symptoms appear inside of the mouth and can also be present inside of your cheeks, tongue, gums, inner tissues of your lips, and palate.

Lesions can either be white and lacy, and resemble spiderwebs, or can be tender, soft, and swollen patches that appear bright red. They could also appear as open sores (ulceration). White and lacy lesions do not cause much pain and discomfort. However, you may experience pain and discomfort when you have red and swollen lesions or in the case of open sores.

Apart from this, symptoms of oral lichen planus include the following.

• Burning pain in the affected region.
• Increased sensitivity to spicy, acidic, or hot foods.
• Pain and discomfort while eating, speaking, or drinking.
• Inflammation of gums, which includes bleeding when brushing your teeth.

Although the exact causes of oral lichen planus are not clear, doctors know that several things could play a major role in the occurrence of these lichen planus. These could be:

• Oral lichen planus can run in your family.
• It could be linked to hepatitis C and many individuals are infected with the virus.
• Oral lichen planus could be linked to your immune system. Your immune cells attack bacteria and viruses and keep you safe. However, in the case of oral lichen planus, those cells start attacking the lining of your mouth.

Certain things can trigger oral lichen planus. These include:

• Certain medications, such as painkillers, diabetes drugs, high blood pressure treatment medicines, and malaria medications.
• Other mouth problems, such as a habit of biting your tongue or cheek.
• Injury to the mouth
• A reaction to metal in your mouth, such as dental fillings.
• Infection and food allergy.

Diagnosis of oral lichen planus will be based on:

• Physical examination of your mouth, and other appropriate areas.
• Discussion of your dental and medical history and the medications you might be taking.
• Review of symptoms, including the white patches or lesions in your mouth and other places of your body.

Diagnosis could include the following laboratory tests. ⁽⁵⁾

Blood Tests: Blood tests would be recommended to identify conditions like hepatitis C, which are rarely associated with oral lichen planus, and lupus, which usually look similar to oral lichen planus.

Biopsy: Biopsy helps to look for indications of oral lichen planus. A small tissue sample is taken from lesions in you’re the affected person’s mouth and examined under a microscope for any indications of oral lichen planus.

Cultures: Using a cotton swab a sample of cells is taken from the infected individual’s mouth and then it is examined under a microscope to determine if there is a presence of secondary fungal, bacterial, or viral infection.

There is no cure for oral lichen planus, so the primary treatment aims at helping severe lesions heal and reducing pain and discomfort associated with the same. Your healthcare provider will monitor your condition and prescribe the most appropriate treatment as required.

Usually, if you do not have pain and discomfort and only white and lacy lesions are present in the mouth, you might not require any treatment. However, below are some treatment options if you have more severe symptoms of oral lichen planus.

Topical numbing agents are the treatments used to provide temporary relief for painful areas in the case of oral lichen planus.

Corticosteroids are used to reduce inflammation in the case of oral lichen planus. There are various forms of corticosteroids. Some of the recommended forms of corticosteroids could be:

Topical: Ointment, mouthwash, or gel are applied directly to the mucous membrane.

Oral: These forms of corticosteroids are taken as a pill for a certain amount of time.

Injection: The medication is directly injected into the lesion.

Medications that suppress or modify the body’s immune response could be used to improve severe lesions and reduce pain or discomfort. These immune response medications come in the following forms.

Topical Ointments or Gels: Calcineurin inhibitors are used to prevent rejection of transplanted organs, and could be effective for treating oral lichen planus. However, because of an unclear association with cancer, these medicines have a warning from the Food and Drug Administration (FDA).

Systemic Medication: Systemic medications that suppress the immune system must be used in severe cases, where oral lichen planus also involves the scalp, genitalia, or esophagus.

NOTE: The use of certain medications, such as topical steroids, can cause side effects like it can cause an overgrowth of yeast. Not treating the secondary infections might worsen the condition. So, during treatment for oral lichen planus, there must be regular follow-up visits with your doctor to check for secondary infections and take essential treatments for the same.

Apart from regular medical treatment, certain self-care measures, lifestyle, and home remedies could be beneficial in improving your symptoms of oral lichen planus and also help prevent recurring episodes of severe symptoms of oral lichen planus.

Practice Good Oral Hygiene: Practice good oral hygiene and keep your mouth clean. This could prevent infection and help in reducing symptoms (if present). Brush your teeth twice a day and floss daily.

Avoid Irritants: Avoid tobacco or alcohol. Apart from this, also avoid causing injuries to the inside of the mouth, such as chewing on your cheek or lip.

Adjust Your Diet: Limit spicy, acidic, and salty foods as they can trigger or worsen your symptoms. Instead, choose foods that are soft. Additionally, stop using caffeine.

Manage Stress: One more thing to keep in mind is to avoid stress because it complicates symptoms or triggers the recurrence of symptoms. Talk to your mental health professional if you are experiencing stress.

Oral lichen planus is a non-contagious form of lichen planus. It is not dangerous but can be irritating at times. Oral lichen planus could be linked to your immune system. So a proper diagnosis of the condition is essential. If you have frequent flare-ups, consult with your doctor.

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