Can Lichen Sclerosus Affect the Mouth?
Yes, lichen sclerosus can affect the mouth or oral mucosa. Lichen sclerosus is a chronic inflammatory disease of mucocutaneous (affecting the mucous membranes) origin. It usually appears in the anorectal region but can affect the oral mucosa as well. Females are mostly affected at least 6 times more than males. It is mostly seen in post-menopausal women; however pre-menopausal women can also be affected. In this condition the skin becomes thin, white and wrinkled that can lead to itching and pain.
Causes and Symptoms of Lichen Sclerosus
Its etiology remains unknown, but several factors have been suggested to cause lichen sclerosus namely auto-immune disease where the body’s immune system attacks and injures its own skin, genetic predisposition, trauma, hormonal changes (known to affect pre-pubertal girls and postmenopausal women and treatments such as hormone replacement therapy and application of progestetone and testosterone are not effective in these people), thyroid disease, anemia, diabetes, alopecia areata, vitiligo and infections leading to chronic irritation.
Lichen sclerosus lesions can range from small patches that are white in color to large plaques, which may or may not be associated with atrophy and sclerosis. Genitals and anal region are the most commonly affected sites with lichen sclerosus. The other sites where lesions can be found are the thighs, breasts, submammary area, neck, back, chest, shoulders and wrists but here they usually remain asymptomatic.
In lichen sclerosus the oral cavity lesions are very rare and usually associated with genital lesions and skin abnormalities. The lesions appear to be well demarcated, white to grey colored macules or plaques, which can be variable in size and number and similar to the lesions found in the genitals. The buccal, labial and palatal mucosa are the most commonly affected intraoral sites. However, the reported cases of people with oral lesions due to lichen sclerosus have been very few and affect about 20% of the cases along with other extragenital areas.
The other conditions which can be confused with Lichen Sclerosus are leukoplakia, lichen planus, localized scleroderma and vitiligo.
Diagnosis of Lichen Sclerosus
A thorough history of the patient along with physical examination is the basic step to identify the condition. A skin examination of the genitals and other susceptible areas is done to look for signs of lichen sclerosus. A biopsy is done to confirm the diagnosis of lichen sclerosus. In this a small piece of skin is removed and sent to be examined by a pathologist.
Tests are also done to exclude other similar skin conditions such as lichen planus, which occurs together with lichen sclerosus. Lichen sclerosus should be differentiated from lichen planus as in the oral cavity; it is clinically indistinguishable from lichen planus. Biopsy is the gold standard to differentiate lichen sclerosus from lichen planus.
Diagnosing lichen sclerosus in the early stages is important for effective management and also to reduce the risk of developing or missing a diagnosis of skin cancer. Typically a yearly examination of vulvar skin is recommended and self-examination should also be done for lumps and sores that do not heal. A biopsy should be done for the areas that do not improve with treatment. Lichen sclerosus lesions in men that affect the skin in penis are more susceptible to squamous skin cell carcinoma of the penis.
Treatment and Management of Lichen Sclerosus
The goal of treatment is to relieve the symptoms and prevent them from worsening any further. Steroid ointments are usually given to soothe itching and inflammation such as clobesatol proprionate that is effective in majority of women with genital lichen sclerosus. Steroid injections may also be given when ointments are not effective. Other topical ointments used are tacrolimus and pimecrolimus used mostly in people who do not respond well to steroid treatment.
Treatment of oral lichen sclerosus is not really required since it is asymptomatic and benign and has no evidence of recurrence. The only concern about oral lichen sclerosus is of cosmetic nature, which can be managed with topical application of steroids.
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