Oral lichen planus

Oral lichen planus (LIE-kun PLAY-nus) is an ongoing inflammatory condition that affects mucous membranes inside the mouth. There are several different types of lichen planus that affect the mouth, but the two main types are:

• Reticular. This type appears as white patches in the mouth and can look lacy. It's the most common type of oral lichen planus. It usually has no related symptoms. And it usually doesn't need treatment or lead to major complications.
• Erosive. This type appears as red, swollen tissues or open sores. It may cause a burning feeling or pain. A healthcare professional should check erosive oral lichen planus regularly because it can lead to mouth cancer.

Oral lichen planus can't be passed from one person to another. The condition occurs when the immune system attacks cells of the oral mucous membranes for reasons that aren't known.

Symptoms usually can be managed. But people who have oral lichen planus need regular checkups. That's because oral lichen planus — especially the erosive type — may raise the risk of getting mouth cancer in the affected areas.

Symptoms of oral lichen planus affect the mucous membranes of the mouth.

Appearance

Signs differ based on the type of oral lichen planus. For example:

• Reticular. This type appears as white patches and can look lacy.
• Erosive. This type appears as red, swollen tissues or open sores.

Location

Signs of the condition may appear on the:

• Inside of the cheeks, the most common location.
• Gums.
• Tongue.
• Inner tissues of the lips.
• Palate.

Pain or other discomfort

The white, lacy patches of reticular oral lichen planus may not cause pain, soreness or other discomfort when they appear on the insides of the cheeks. But symptoms of erosive oral lichen planus that may occur along with red, swollen patches or open sores include:

• Burning sensation or pain.
• Sensitivity to hot, acidic or spicy foods.
• Bleeding and irritation with toothbrushing.
• Inflammation of the gums, also known as gingivitis.
• Painful, thickened patches on the tongue.
• Pain when speaking, chewing or swallowing.

Other types of lichen planus

If you have oral lichen planus, lichen planus may affect other parts of your body, including:

• Skin. Depending on skin color, lichen planus usually appears as purple or violet, flat-topped bumps that are often itchy.
• Genitals. Lichen planus on female genitalia often cause pain or burning and discomfort when having sex. The spots usually are red and eroded. Depending on skin color, sometimes they look like white areas. Lichen planus also can occur on male genitalia.
• Ears. Lichen planus of the ears can lead to hearing loss.
• Nose. Frequent nosebleeds and lasting congestion can occur.
• Scalp. When lichen planus appears on the scalp, it may cause short-term or long-term hair loss. This hair loss could be permanent if not treated.
• Nails. Although rare, lichen planus of the toenails or fingernails may result in ridges on the nails, thinning or splitting of nails, and short-term or long-term nail loss.
• Eyes. Rarely, lichen planus may involve the mucous membrane surfaces of the eyes, possibly causing scarring and blindness.
• Esophagus. Lichen planus of the esophagus is rare. But when it occurs, it may narrow the esophagus or form tight, ringlike bands in the esophagus that can make swallowing hard.

When to see a doctor

See your doctor or other healthcare professional if you have any of the symptoms listed above.

It's not known what causes oral lichen planus. But T lymphocytes — white blood cells involved in inflammation — appear to be activated in oral lichen planus. This could mean that it's an immune condition and it could involve genetic factors. More research is needed to find the exact cause.

In some people, certain medicines, mouth injury, infection or allergy-causing agents such as dental materials may cause oral lichen planus. Stress may cause symptoms to get worse or come back from time to time. But these causes are not confirmed.

Anyone can get oral lichen planus, but it's more common in middle-aged adults, particularly women over age 50. Some factors may raise your risk of getting oral lichen planus, such as having a condition that lowers your immunity or taking certain medicines. But more research is needed.

Severe cases of oral lichen planus may raise the risk of:

• A lot of pain.
• Weight loss or not getting enough nutrition.
• Stress or anxiety.
• Depression.
• Scarring from erosive sores or other affected spots.
• Secondary oral yeast or fungal infections.
• Mouth cancer.

Your healthcare professional may make a diagnosis of oral lichen planus based on:

• Talking with you about your medical and dental history and the medicines you're taking.
• Going over symptoms happening in your mouth and any other places on your body.
• Looking at your mouth and other areas as needed.

Your healthcare professional also may request lab tests, such as:

• A biopsy. In this test, a small tissue sample is taken from one or more spots in your mouth. This sample is studied under a microscope to see if oral lichen planus is present. Other, more specialized microscopic tests may be needed to find immune system proteins commonly related to oral lichen planus.
• Cultures. A sample of cells is taken from your mouth using a cotton swab. The sample is examined under a microscope to look for a secondary fungal, bacterial or viral infection.
• Blood tests. These tests may be done to find conditions such as hepatitis C, which may rarely be related to oral lichen planus, and lupus, which may look like oral lichen planus.

Oral lichen planus is a lifelong condition. Mild forms may go away on their own but flare up later. Because there is no cure, treatment focuses on healing and easing pain or other symptoms that bother you. Your healthcare professional watches your condition to find the best treatment or to stop treatment as needed.

If you have no pain or other discomfort, and you only have white, lacy signs of oral lichen planus in your mouth, you may not need any treatment. For more-severe symptoms, you may need one or more of the options below.

Symptomatic treatment

Treatments such as numbing agents applied to the skin can give relief for a short time in areas that are very painful.

Corticosteroids

Medicines called corticosteroids may lower inflammation related to oral lichen planus. Your healthcare professional may recommend one of these forms:

• Medicine placed on the skin. You apply mouthwash, ointment or gel directly to the mucous membrane — the preferred method.
• Medicine taken by mouth. You take corticosteroids in pill form for a limited time.
• Medicine taken as a shot. This medicine is injected directly into the affected area.

Side effects vary depending on the method you use. Talk with your healthcare professional to weigh the possible benefits and side effects.

Immune response medicines

Medicines called immunosuppressants may be used to improve severe symptoms of oral lichen planus and lessen pain. But they're only for people who do not have weakened immune systems because these medicines can weaken or change the body's immune response. They come in these forms:

• Ointments or gels applied to the skin. In ointment or gel form, these immune response medicines may effectively treat oral lichen planus. Examples include tacrolimus (Protopic) and pimecrolimus (Elidel). While these medicines have a U.S. Food and Drug Administration warning because of an unclear link with cancer, they are commonly used for oral lichen planus. Talk with your healthcare professional about any potential risk.
• Systemic medicine. For severe oral lichen planus that also involves other areas, such as the scalp, genitalia or esophagus, systemic medicines that weaken the immune system may be suggested, weighing the benefits and risks.

The use of some medicines, such as steroids placed on the skin, can lead to the overgrowth of yeast. This is known as a secondary infection. During treatment, schedule regular follow-up visits with your primary healthcare professional to check for secondary infections and get treatment. Not treating secondary infections may worsen oral lichen planus.

Ask your doctor or other healthcare professional about the benefits and risks of using medicines in any form.

Dealing with triggers

If your oral lichen planus seems linked to a trigger, such as a medicine, an allergen or stress, your healthcare professional can recommend how to deal with the trigger. For example, suggestions may include trying another medicine instead, seeing an allergist or dermatologist for more testing, or learning stress management techniques.

In addition to regular medical and dental treatment, these self-care measures may make your oral lichen planus symptoms better or help prevent episodes of severe symptoms from coming back from time to time:

• Keep your mouth clean. Doing so can ease your symptoms and help prevent infection. Floss daily and gently brush your teeth at least twice a day using a mild toothpaste without much, if any, added flavor.
• Change your diet. Cut out spicy, salty or acidic foods if they seem to cause your symptoms or make them worse. Choose foods that are soft to help limit pain. And use less caffeine or stop using it.
• Avoid irritants. Don't use alcohol or tobacco. Also stop habits that can injure the inside of your mouth, such as chewing on your lip or cheek.
• Learn to manage stress. Because stress may complicate symptoms or cause symptoms to come back, you may need to build skills to avoid or manage stress. Your healthcare professional may refer you to a mental health professional who can help you figure out what's causing your stress, create stress management plans or take care of other mental health concerns.
• See your dentist or other healthcare professional regularly. See your dentist twice a year for checkups and cleanings, or more often as directed. Because long-term treatment for oral lichen planus is often needed, talk with your healthcare professional about how often you should be seen to track how your treatment is working and to get cancer screening.

You'll likely start by seeing your primary healthcare professional or dentist. You may be referred to a specialist in gum and dental diseases, also known as a periodontist, or a specialist in skin diseases, also known as a dermatologist.

What you can do

To get ready for your appointment:

• Bring copies of all previous medical reports and test results you've had about this condition.
• Ask if there's anything you need to do before the appointment, such as limit your diet.
• Make a list of any symptoms you're having, including any that don't seem related to your mouth.
• Make a list of key personal information, including any major stressors or recent life changes.
• Make a list of all medicines, vitamins, herbs or other supplements that you're taking, and the doses.

Also, prepare questions to ask your healthcare professional. Some basic questions to ask include:

• What's likely causing my symptoms or condition?
• What are other possible causes?
• What kinds of tests do I need?
• What's the best course of action?
• What are the options to the main approach that you're suggesting?
• I have other health conditions. How can I best manage them together?
• Are there any restrictions that I need to follow?
• Should I see a specialist?
• Is there a generic option for the medicine you're prescribing?
• Are there any printed materials that I can have? What websites do you recommend?

Don't hesitate to ask any other questions during your appointment.

What to expect from your doctor

Your healthcare professional is likely to ask you several questions, such as:

• When did your start seeing the sores or other areas of concern in your mouth?
• Do you have sores or similar spots anywhere else on your body?
• Do you feel any pain, burning sensations or other discomfort in your mouth?
• How bad is your pain?
• Have you recently started taking new medicines?
• Do you take vitamins, herbs, other dietary supplements or nonprescription medicines?
• Do you have any allergies?
• Have you had any new or unusual stresses in your life?
• What other health conditions do you have?

Your healthcare professional will likely ask more questions based on your responses, symptoms and needs. Prepare for questions to make the most of your appointment time.