Oral Lichen Planus

Oral Lichen Planus (OLP) is a chronic inflammatory oral cavity disorder which may arise on its own or accompanied with Lichen Planus of the skin. Know all about this common mouth disorder, including its possible causes, symptoms, diagnosis, and treatment options.

Oral Lichen Planus Definition

It is a persistent medical condition which affects the mucous membranes of the mouth and gives rise to papules, bilateral white striations, plaques on the gingivae and tongue. These forms of Lichen Planus lesions are not transmittable and have a distinct clinical morphology.

Oral Lichen Planus Incidence

It is a T-cell-mediated seditious mucosal disorder representing hypersensitivity. Older adults and middle aged people above the age of 40 are more prone to the syndrome. The predilection of the disorder for females to males is 2:1.  In the US, 1-2% of the total population gets affected by this syndrome. It is a widespread non-infectious oral mucosal disease among adults who attend oral medicine and pathology centers on a regular basis.

Oral Lichen Planus Causes

The actual cause of the syndrome is still unknown. However, according to medical practitioners, this autoimmune disorder arises when the autocytotoxic CD8+ T cells activate the oral epithelial cells. The lesions experienced during such disorders arise due to the inflammation administered by the white blood cells, known as T-Lymphocytes. Generally, the cells are active at the site of the wound. According to medical research studies, however, a few other factors which may trigger the syndrome may include:

• Hepatitis B vaccine
• Allergy-causing agents (allergens), such as foods, dental materials or other substances
• Certain medications for heart disease, high blood pressure or arthritis
• Hepatitis C infection and other types of liver disease
• Certain types of flu vaccines
• Anti-inflammatory and non-steroidal drugs

Oral Lichen Planus Symptoms

OLP can be characterized on the basis of a few factors, including:

Appearance

This condition affects the mucous membrane inside the mouth of the patient and may manifest in the form of:

• Swollen, Red, tender patches of tissues
• White, lacy raised patches of tissues
• Open sores

Location

Lesion affecting the mucous membrane of the oral cavity appears on various sites, such as:

• Gums
• Inner lips tissues
• Esophagus
• Inner side of the cheeks
• Tongue
• Throat

Pain

Patients affected by such mouth disorders experience a sharp pain or burning sensation due to the open sores of oral lichen planus or the red lesions. The lacy white patches on the tongue arising due to the disorder are also responsible for the occurrence of the acute pain inside the mouth.

Other signs or symptoms

According to medical researchers, OLP can be identified by some additional signs and symptoms. These include:

• Dry mouth
• Sensitivity to hot and dry foods
• Dull or metallic taste in the tongue
• Difficulty in swallowing
• Irritation during tooth brushing, often leading to bleeding

Other forms of Lichen Planus

If a patient is suffering from OLP, he/she may be experience lichen planus lesions in different parts of the body. These include:

Genitals

Lesions on the exterior genitalia are similar to those occurring inside the mouth and affecting the mucous membrane of the vagina.

Nails

Lichen planus rarely affects the fingernails or the toenails. In a few cases, however, it causes splitting or thinning of the nails. This gives rise to permanent or temporary loss of nails.

Skin

The itchy lesions appear on the skin as purple flat bumps.

Scalp

Presence of skin lesions on the human scalp can give rise to short-term hair fall or even permanent loss of hair.

Oral Lichen Planus Diagnosis

Dermatologists conduct diagnosis of such disorders on the basis of the data and information related to the syndrome. Doctors carefully examine the abnormalities present in the mouth and conduct lab tests if required. Such tests may include:

Hepatitis C test

Hepatitis can often trigger OLP in the mouth of sufferers. Hence, nurses often conduct a simple lab test by drawing blood from patients to determine the Hepatitis C traces.

Biopsy

During such diagnostic procedures, doctors use small tissue samples of the lesions inside the mouth of the patient. With the help of a microscope, the tissue of the lesions is examined to find out the existence of the classic T lymphocytes pattern, common among OLP patients.

Allergy Tests

In rare cases, doctors often recommend the patients to dermatologists or allergy specialists to determine the existence of certain allergic factors which may trigger or give rise to OLP.

Oral Lichen Planus Differential Diagnoses

The differential diagnosis of OLP includes telling its warning signs apart from those of other diseases, such as:

• Oral Manifestations of Autoimmune Blistering Diseases
• Pemphigus Vulgaris
• Squamous Cell Carcinoma
• Dermatitis Herpetiformis
• Graft Versus Host Disease
• Linear IgA Dermatosis

Oral Lichen Planus Treatment

OCP is a complex chronic inflammatory disease. The treatment of OCP aims to heal the severe lesions and reduce the discomfort or pain. After examining the present condition of the patient, doctors prescribe the dosages, change medicines and even stop the treatment. Treatment is not required if OLP patients experience only white lacy lesions without any pain or discomfort. The curing procedure of OLP patients may include:

Retinoids

It is the synthetic form of vitamin A and can be used as a relevant ointment or consumed orally. These topical ointments do not cause any side effects although the mucous membrane of the mouth may be affected. Such oral and topical retinoids should not be used by pregnant women or those who are planning to have a child in future. This is because the drug can lead to permanent birth defects. Doctors often recommend necessary precautions before consuming such medications.

Corticosteroids

Such form of medication minimizes the inflammation which is related with OLP. The possible side effects of the syndrome depend on its usage. Such drug can be used as an ointment that can be applied on the mucous membrane directly. Other forms of its usage may include:

Oral

Using corticosteroids for prolonged period may cause diabetes, deteriorating of the bones, high cholesterol, high blood pressure and various other associated diseases.

Topical

Topical corticosteroids may cause oral thrush infection and reduce the effect of OLP treatment. Regular usage of the drug topically to cure OLP may also lessen the function of the adrenal glands.

Injections

Such medical treatment is generally administered into the lesions directly. Regular use of such injections can give rise to oral corticosteroids.

Nonsteroidal ointments

According to reports of medical survey of the last few years, topical medications such as calcineurin inhibitors have proved extremely effective in curbing the OLP syndrome. Such topical medications, which can cure the inflammation, are pimecrolimus (Elidel cream) and tacrolimus (Protopic ointment).

Lifestyle and home remedies

In addition to medical treatment, several self-care measures can be adapted to reduce the occurrence of the symptoms and prevent them from getting worse. Such procedures include:

Adjusting the diet

Reducing the intake of acidic and spicy food items can improve the symptoms of OLP.

Maintaining good oral hygiene

The mouth should be kept clean at all times in order to prevent the occurrence of the infection and minimize the symptoms. Teeth should be brushed twice and should be kept under regular check-ups.

Oral Lichen Planus Complications

OLP can give rise to a number of complications, including:

Esophageal problems

Lichen planus lesions in the esophagus may give rise to its contraction, making swallowing very difficult.

Cancer

OLP makes patients more prone to oral cancers such as squamous cell carcinoma.  In order to prevent the occurrence of such form of cancer, a number of preventive techniques should be followed. These include:

• Reducing the intake of alcohol
• Oral cancer screenings on a yearly basis
• Reducing the intake of any tobacco products

Oral Lichen Planus Risk Factors

A few factors can make the condition more complicated and worsen the warning signs. These include:

• Alcohol
• Poor-fitting dentures
• Dental plaque or tartar
• Tobacco products
• Bad dental work
• Poor oral habits like biting cheeks or lips
• Stress

Oral Lichen Planus Pictures

Take a look at these images to get an idea about the physical appearance of individuals affected by this condition.

Picture 1 – Oral Lichen Planus

Picture 2 – Oral Lichen Planus Image

Oral Lichen Planus is a hereditary disorder. If you experience sores inside your mouth, or have frequent bleeding sessions, consult your health care provider immediately. Do not neglect the disease, for it can lead to a number of other complications. Timely detection and treatment will help you recover from this condition faster and avoid its complications.

References:

http://see.visualdx.com/diagnosis/lichen_planus_oral

http://emedicine.medscape.com/article/1078327-treatment

http://www.bad.org.uk/site/1291/default.aspx

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3304232/