What is oral lichen planus?

March 17, 2021

  

Lichen is a fungal organism. Planus on the other hand refers to a flat or even surface. The condition called lichen planus doesn't really involve lichen, but the appearance of the condition closely resembles it. Lichen Planus is a chronic condition which is caused due to an inflammatory reaction that is triggered by the person's own immune system. The condition has a range of subtypes depending on the nature, site and presentation of the lesion.

Lichen Planus usually affects the skin, hair, nails, limbs and the oral cavity. The skin and the oral cavity are the most common areas where a lichenoid reaction is likely to occur. Lichen Planus is seen as a lesion that is characterized by the presence of thin white lacy lines called Wickham's striae. These are accompanied by plaques, papules, ulcers, bullae and other degenerative conditions of the skin. The linings of the skin of the affected region develops a rough architecture, that may or may not be pigmented with reddish or purplish lesions.

In the oral cavity, lichen planus can often be a painful condition that can take years to resolve. It is often seen in smokers, patients allergic to dental materials, patients under stress and patients who have a genetic disorder. Lichen Planus in the mouth can be seen on the inner lining of the skin as a whitish lesion that spreads haphazardly. The gingiva often gets eroded and inflammed which can be very painful. Many times, lichen planus is seen as small whitish papules in the oral cavity and is not easily diagnosed. This is because this form often resembles a routine ulceration. Lichen Planus that presents as bullous lesions is rare but most infectious. The bullae are fluid-filled lesions that can be painful if ruptured. The fluid released following the rupture can cause secondary infections. Lichen Planus that occurs on the tongue can lead to soreness and result in loss of taste sensation.

A proper history of the patient, careful examination of the affected site and its surrounding structures and a tissue biopsy are key in the diagnosis of lichen planus. A biopsy of the affected site can often help in ruling out multiple lesion disorders, some of which might also lead to skin or oral cancer.

The mechanisms behind lichen planus of the skin and oral cavity are different. However, this difference is not yet established concretely. Moreover, lichen planus can either be a sole condition present in the patient or can accompany an already underlying disease, syndrome or disorder. Lichen Planus does not necessarily lead to a cancerous state, be it the skin or the oral cavity. The patient who is suffering from lichen planus is kept on a follow-up of 6 months until the lesion is cured.

Lichen Planus is often associated in patients suffering from Hepatitis-C. The lesion is also seen in esophagus and genital regions. Itching and pain in these areas can occur due to the lesion and can cause inflammation in the linings of these organs. Rare forms of lichen planus involves ears, nose, conjuctiva and anus.

Since the exact etiology behind lichen planus is unknown, the treatment is usually targeted towards the associated signs and symptoms. The itching sensation that accompanies the lesion is reduced by application of antifungal ointments. Pain in the affected site can be resolved by taking analgesics in oral form or as topical ointments. The primary mode of treatment, irrespective of whether it is a skin or oral lichen planus, is the administration of corticosteroids. These are drugs that subside the inflammation and promote healing of the lesion. These are available as ointments or creams and as mouthwashes for oral lesions. The healthcare professional can also prescribe vitamin supplements as adjunctive therapy. These are most often rich is Vitamin A. Drugs that try to modulate the immune system like tacrolimus or pimecrolimus are also used sometimes for oral lichen planus. Ultraviolet radiation therapies is said to be effective in some cases.

Lichen Planus can be a highly disturbing condition that can affect the quality of life of an individual. It is said that the lesion resolves in 2 years. However, the condition can prolong if it has a potential to become cancerous. Diagnosis of the lesion through tissue biopsy at the earliest can thus help in timely management of the condition.

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