Oral Lichen Planus – Diagnosis and Treatment
Diagnosis
Doctors use several steps to identify oral lichen planus and its various forms, such as reticular, erosive, hypertrophic, and atrophic types.
The evaluation often begins with a discussion about the person’s medical and dental history, including what medicines they take and symptoms they have in their mouth or on their skin.
Health professionals carefully check the oral mucosa, especially the buccal mucosa, for common signs like white, lace-like patterns called Wickham’s striae, red or swollen patches, and oral lesions.
Key Diagnostic Steps:
Visual Examination: Doctors look for Wickham striae, erosive or atrophic areas, and different oral lesions. They also watch for signs linked to lichen planopilaris, cutaneous or genital lichen planus, and the Koebner phenomenon.
Tissue Biopsy: Doctors take a small tissue sample and study it under a microscope. Histology confirms changes linked to oral lichen planus. Sometimes, they use direct immunofluorescence to check for immune proteins.
-
Lab Tests:
- Cultures help find any added mouth infections.
- Blood tests check for hepatitis C (HCV infection) or conditions with a similar clinical presentation, such as lupus.
Timely and accurate diagnosis is important, as erosive oral lichen planus and vesiculobullous types may have a risk of malignant transformation.
Treatment
Methods for Reducing Discomfort
People with oral lichen planus often experience discomfort, especially during flare-ups. Short-acting numbing products, like topical anesthetic gels or rinses, can lessen pain for a limited period.
These products are usually applied right to the sore spots to give temporary relief, making it easier to eat or speak.
Other simple actions may help, such as avoiding spicy or acidic foods. Keeping up with good oral hygiene and visiting a dental professional regularly also supports overall mouth health.
Use of Anti-Inflammatory Medicines
Doctors often choose corticosteroids to reduce inflammation and control symptoms. These medicines come in various forms, such as:
- Topical Forms: Mouthwashes, ointments, gels, or pastes with corticosteroids are commonly used. Patients apply these directly onto the affected tissues for best results.
- Oral Forms: Sometimes, doctors prescribe corticosteroid tablets if the condition does not improve with topical treatment. They usually use systemic corticosteroids for short periods due to possible side effects.
- Injections: For hard-to-treat areas, doctors inject steroids straight into the lesions. Intralesional corticosteroids may help in specific cases.
Possible side effects depend on the type used. Topical steroids may sometimes lead to secondary infections like yeast overgrowth. Systemic steroids can have broader side effects if used too long.
| Form | When Used |
|---|---|
| Topical | Most common, preferred for oral sores |
| Systemic (oral) | For severe or widespread lesions |
| Injection | When topical is not effective |
Medicines That Adjust Immune Function
For individuals who don’t respond to corticosteroids or have more severe oral lichen planus, doctors may suggest medicines that affect the immune system.
These medicines, also called immunosuppressants or immune modulators, are available in different forms:
- Topical Immune Modulators: Gels or ointments such as tacrolimus or pimecrolimus are sometimes used when steroids are not enough. While these products are effective, people should talk with their healthcare professional about the risks and benefits.
- Systemic Immune Therapies: In rare cases of severe disease, doctors may consider using an oral retinoid. These medications are prescribed cautiously and require regular monitoring due to potential side effects.
- Phototherapy: While more commonly used for skin lichen planus, doctors sometimes discuss light-based treatments for broader disease involvement.
All immune-modifying medicines carry risks, including a higher chance of certain infections. Regular follow-up visits are important for anyone taking these therapies.
Handling Contributing Factors
Certain triggers may make oral lichen planus worse. Common triggers include specific medications, allergens, and emotional stress. Addressing these factors can sometimes lessen flare-ups or make other treatments work better.
Doctors may suggest switching to different medicines if they suspect a drug as the cause. An allergist can help rule out contact allergies. Stress-reduction techniques, such as mindfulness or counseling, are also sometimes recommended.
By working to control known triggers, people with oral lichen planus may have fewer symptoms and better manage their condition.
Everyday Habits and At-Home Care
Taking good care of your mouth can help ease symptoms of lichen planus and may reduce flares.
| Self-Care Step | Purpose |
|---|---|
| Gentle oral hygiene | Reduce infection & irritation |
| Diet changes | Avoid triggering foods |
| Avoid irritants | Protect mouth and other areas |
| Manage stress | Lower risk of flare-ups |
| Regular checkups | Monitor for complications |
Simple actions like brushing teeth gently twice a day and flossing daily help keep the mouth clean. Using mild, low-flavor toothpaste can also limit irritation, especially for those with sensitive mouth tissues.
Changing what you eat can make a difference. Foods that are soft and mild may help reduce pain, while spicy, salty, or acidic foods should be avoided if they seem to make symptoms worse.
Limiting or stopping caffeine can also lessen mouth discomfort.
Steering clear of irritants is important. Using alcohol or tobacco can worsen symptoms. Avoid habits like biting the lips or cheeks, as these can injure the mouth lining and make healing harder.
Stress can affect lichen planus and sometimes causes symptoms to return. Some people find it helpful to use relaxation techniques or seek support to manage stress.
A healthcare provider may suggest seeing a mental health professional for better stress management.
Dental checkups and cleanings should be done at least twice a year or as often as advised. Long-term follow-up supports early detection of problems, such as scarring, changes in the nails, scalp lesions, or even cancer screening if needed.
People dealing with lichen planus on the genital mucosa, scalp, or as scarring alopecia may need to protect these areas by following similar self-care steps.
Good daily care can help protect quality of life and might reduce issues like burning sensation or hyperpigmentation.
Getting Ready for Your Visit
Steps You Can Take Before Your Appointment
Being prepared for your visit can help you get answers more quickly and make the most of your time. Here are simple ways to get organized:
- Collect Medical Records: Bring all past medical reports, lab tests, and any documents about your oral or skin issues. This is important if you have had symptoms like pruritic, flat-topped papules, or violaceous papules before.
- Symptom List: Write down your symptoms, even if some do not feel connected to your mouth or skin. Include details such as when you first noticed them, if you have pain, or if the spots itch or burn.
- Medication Update: Make a complete list of all medicines, vitamins, and supplements you use. Write down the doses. This helps your healthcare professional spot causes like lichenoid drug eruption or reactions involving other medicines.
- Personal Notes: Record any key life changes, stress, or other health problems. Sometimes, lichen planus can develop after stressful events or alongside other conditions like hepatitis or candidiasis.
- Plan Your Questions: Prepare a set of questions to ask during the appointment. Example questions are shown in the table below.
| Suggested Questions to Ask |
|---|
| What is likely causing my problems? |
| What other causes are possible? |
| What tests will I need? |
| What treatments are available? |
| Should I see a skin or dental expert? |
| Are there specific restrictions I should follow? |
| Is my case related to hepatitis or another illness? |
| Could this be something else (like secondary syphilis or pemphigus)? |
| What long-term risks should I watch for, such as squamous cell carcinoma? |
Having your questions and information ready helps you get better answers and reduces missed details.
What Healthcare Professionals Will Discuss
During the visit, your healthcare provider will ask detailed questions about your mouth, skin, medication use, and any other symptoms. They may ask:
- When did you first notice the sores, papules, or color changes?
- Have you found similar spots on other parts of your body?
- Are you having pain, itching, or problems eating?
- Have you recently started new medication or supplements?
- Any history of hepatitis, especially hepatitis C virus?
- Do you have allergies or other health concerns, like candidiasis or other skin problems?
- Any signs of other diseases that might look similar, such as secondary syphilis or pemphigus?
Your healthcare provider will also check for risk factors linked to lichen planus and monitor for related complications like squamous cell carcinoma.
Be ready to answer follow-up questions based on your responses, which will help guide the exam, suggest testing (such as a biopsy if needed), and personalize your treatment.
