Oral Lichenplanus – Clinical features, Histopathology, Diagnosis & Treatment

Oral Lichenplanus – Clinical features, Histopathology, Diagnosis & Treatment

Lichens are primitive plants composed of algae and fungi. Planus means flat in Latin. Erasmus Wilson coined this term, probably because he thought the lesion was similar to the lichens growing on rocks. Lichen planus is a chronic muco-cutaneous disease of auto-immune origin, affecting around 0.2– 2 % of the population. Oral lichen planus (OLP) could either accompany the cutaneous/skin lesions or precede them. Stress and anxiety are known to be significant factors in inducing this condition. There are reports, however, stating that this could be anecdotal and that it lacks enough evidence. Reports of an association with Hepatitis C have appeared in literature, usually from the Mediterranean countries, but more recent epidemiological studies do not support this association. A variety of drugs and other foreign bodies may elicit a host response to induce these lesions in the oral cavity, but these type
of lesions are better designated as lichenoid mucositis or lichenoid lesions. Ultimately no one yet knows what causes this disease and is generally considered to be an auto-immune in nature. Most patients of OLP are middle aged with a male: female ratio of 2:3. OLP manifests in a variety of clinical variations: reticular, atrophic/erythematous, erosive/ulcerative, plaque/hypertrophic type and bullous type. Reticular OLP is the most common type, manifesting frequently in the buccal mucosa bilaterally and symmetrically, and also occasionally on the tongue, gingiva and lips. It is characterised by numerous interlacing white keratotic lines or striae called Wickham’s striae. Is usually asymptomatic or presents with minimum clinical symptoms. This form of the disease usually presents
as red patches in conjunction with reticular striae and with the erosive variant. Patient may complain of burning sensation
and discomfort. This manifestation of the lesion usually appears on the gingiva producing a pattern called desquamative gingivitis. But this term is not strictly reserved for
OLP and is rather a vague, broad clinical term that includes other conditions like Pemphigus vulgaris, Cicatricial pemphigoid, Epidermolysis bullosa and linear IgA disease. It also frequently occurs on the buccal mucosa. The erosive form of OLP manifests with an ulcer covered with pseudomembranous exudate associated with reticular striae and also erythematous patches. Patients may complain of a sore mouth and difficulty in mastication. White raised or flat plaques may occur as a variant of the lesion usually on the tongue and buccal mucosa. This form of OLP is difficult to distinguish
from leukoplakia. It may occur in conjunction with a white striae and may be an irregular to smooth plaque, often involving more than one area of the
affected site. OLP also manifests as patchy areas of reactive melanosis in people of colour due to stimulation of the melanocytes by the inflammatory cells. Microscopically, the reticular and the plaque type of OLP manifest with epithelial hyperkeratosis with focal areas of atrophic epithelium in
between. There may be acanthosis of the spinous layer with pointed saw-tooth rete pegs. The immediate adjacent connective tissue consists of a band of dense layer of inflammatory cells composed predominantly of T-lymphocytes obscuring and degrading the basement membrane and infiltrating the epithelium. The erosive and atrophic forms have the same features under the microscope, except that the epithelium is relatively thinned and destroyed by the inflammatory cells. Microscopic diagnosis can be aided by immunofluorescence where it would be positive for fibrinogen and negative for IgA, IgM and IgG antibodies. Clinically it becomes very important to differentiate OLP from other lesions because OLP is classified as a potentially malignant disorder. The reticular pattern may have to be differentiated from other lesions like lichenoid lesions due to drugs, restorative materials, GVHD and lupus erythematosus. The erythematous and erosive type may resemble conditions like pemphigus vulgaris, mucous membrane pemphigoid, atrophic candidiasis, lupus erythematosus and erythroplakia. The plaque type may be difficult to distinguish from leukoplakia. Remember that the bilateral reticular pattern on the buccal mucosa are very characteristic. Even if it manifests as other variants, look
for focal areas of white striae. If there are isolated OLP like lesions on
sites like the ventral surface of tongue, soft palate or the floor of the mouth, a biopsy is recommended to rule out any malignant changes. There are 2 sets of criteria used to diagnose OLP. One was proposed in 1978 by the WHO and the other set of guidelines were put forth by van der Meij and associates in the year 2003. Criteria proposed in 2003 were essentially modified from the previous WHO set of guidelines proposed in 1978 Whether one set of guidelines is more accurate than the other is debatable, but there have been studies,stating 2003 guidelines to have less of a subjective bias. Corticosteroids are the most useful group
of drugs in the management of oral lichen planus. Topical application of corticosteroids like
Triamcinolone acetonide, betamethasone, clobestosol could be effective in inducing healing within a week or two. However, the patient must be informed of a potential flare up, when the topical application is stopped. Antifungal therapy along with topical corticosteroids may enhance clinical results due to elimination of secondary colonization of candida in OLP sites. Systemic topical Vitamin A analogs have also been used with varied degree of success. Patients must be kept under routine follow-up, due to the potentially malignant nature of OLP A good oral hygiene and aversive habits of tobacco or alcohol habits are to be avoided.

56 comments / Add your comment below

  1. thanks so much.. it's really help me to understand lichen planus .. i love the way you explain this disease please keep going
    this mix between art and Science is perfect
    can you add the differential diagnosis in you're next Video

  2. Thank you for the detailed explanation on OLP. Please let us know about the treatment part as well and where is Hack Dentistry located in the US?

  3. Thanks for the detailed information on OLP Dr. Sanket. This video has been helpful and I like to understand the different variations of Lichen plans narrated via diagrams. So I go over and over again to figure out what I could have. I find little of every symptom in me for eg. OLP Granuloma and pemphigold.
    Proud of Chennai India dentists who know their subject well. I live in New Jersey but will make a trip to Chennai Hack dentistry to get diagnosed when I visit India. Some of the dentists I visit here do not know what is Oral Lichen Planus and my dentist here referred me to Periodontist.

  4. it's really good ( explanation and etc).
    but can you please make a video on L.P.P ( lichen planus pigmentation).. plz plz plz
    and I think it would be better to mention precautions to be taken and time required to cure .
    so ..
    plz plz plz…

  5. Thank you so much for such a good explanation and visual effects…. Really helps to understand the topic better!
    Please keep posting such videos 😀

  6. I am told that Lichen Planus can turn into cancer. In that case what is the treatment for the cancer? Nothing I have tried has worked. I have seen 3 dentists, 1 ent guy and 3 Dermatologists; I am the end of my rope and in a lot of pain.

  7. My doctor said I had oral lichen planus. He told me:
    1. not to use chewing gums
    2. not to use toothpaste or listerine etc, just to brush my teeth with water
    3. reduce and quit smoking (I reduced it greatly).

    In 2 days it was gone!!!!

  8. Thanks a bunch, Hack Dentistry.. I just can't seem to understand the topic by means of just reading the book (Regezi). I've grown up to understand by watching, so this helped alot

  9. Please add all tumors of odontogenic origine, this is very useful to understand the whole scenario, of book and too Gud for quick revision.

  10. I love the way you explain it. It makes me understand easily. Thank you so much for these videos. I appreciate your efforts.
    I have one request, if you can start making videos of other dental subjects too then it will help us more. Please consider this thought. Once again thank you so much sir.

  11. There is a ELISA method in which there are three test referred by doc.i.e. DSG-1, DSG-3 and BPAG-1. can these test be done in India. it is very urgent. 7696616608 or email any help to [email protected] e-mail id.

  12. Thank you for a very professional, in-depth but easy to understand for the layman too. One thing not mentioned is the association of OLP with dry-mouth syndrome? My saliva is thick. At times my mouth is bone dry. I assume it is connected with my OLP? Another point. I have tried to find an on-line support group but the only ones I came across are almost non-active. I have been unable to eat solid food for 3 months now and, at times, find this frustrating and depressing. I would love to be able to discuss my issues with other sufferers who may be able to help. Thank you once again.

  13. I am so tired of having this disease! I'm from New Mexico and can't eat hot green chile or chips as they poke the sores,…. This sucks and Nothing works to make it go away. I did have Hep C but no longer. I din't drink, smoke or do drugs any more (4 years). I got sober for this? Damn it man! Anyway I feel for anybody who is going through this stuff. Peace!

  14. I have oral lichenoid lesions..OLL…from past 7months…i ve visited almost 7doctors..no medicines are working.i am frustrated now…neither i smoke or drink..i avoid spicy food…but no solution till now..

  15. I've had this condition for about 7 years it's gotten worse because of my stress but my suggestion for anybody is to use Biotene toothpaste and also the mouth spray cuz I've developed dry mouth because of this condition

  16. Do this occur in 5years kid..? My daughter has white patches inside her cheek, lips, tongue. For 6months several trial and error method for curing the same done with medication like fluconozel, colostrum, probiotics, candida mouth gel etc but it recurred after 2months, and now doesn't heal with fluconozel, candida mouth gel etc.. She had 3times fever in 20-25 days interval too.. Now CBC with LFT, total Ig test, c3,c4,cd4,cd8 done, only hb 9.3% and IgE 276 ,rest normal. Doctor given anti allergic medicine but doesn't work.

  17. Hello, can you leave me your contact mail so I can send you pictures of my tongue? I can't tell if it is leucoplakia or lichen.Also, my doctor has not made a correct diagnosis for me,he is not sure is it leucoplakia or not.

  18. I was just diagnosed as oral lichen planus and I am only 24 😥 The burning sensation whenever I try anything hot or spicy really irritates me because in my country(South Korea) it is literally impossible to find a single food without hot pepper..

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