What is Lichen Planus?
Abbreviated as LP, it is an inflammatory condition of the skin, which can also affect the lining of the mouth, the tongue, or even the gums. In the mouth it appears as white, lacy patches on the surface, or sometimes as sore red areas.
Oral lichen planus is not common and mainly affects adults over 40, but can occur at any age. The problem is not caused by an infection and is not therefore contagious.
Signs and symptoms
The changes to the mucous membrane or “skin layer” inside the mouth make it sensitive to hot, spicy, or acidic foods and drinks, often causing a burning sensation. There is also likelihood of spontaneous bleeding when the toothbrush touches affected areas of the inside cheek lining or the gums.
The tongue and/or gums can appear red and shiny if affected, or there can be ulcers or erosions in various areas (‘erosive’ lichen planus) and these are especially painful.
The cause of oral lichen planus is not completely understood, but is thought to be connected to the body’s immune system functioning incorrectly. It is as though the body’s immune system fails to recognise its own tissues and attacks them. This evokes an inflammatory response with an increase in white cells or leukocytes.
Certain factors seem to trigger the condition in some people and these can include;
- hepatitis infection,
- non-steroidal anti-inflammatory drugs like ibuprofen,
- some cardiovascular drugs, and
- agents which provoke an allergic reaction. These might be specific foods, or even dental fillings, which occasionally cause a localised reaction in the lining of the cheek, near back teeth heavily filled with silver amalgam.
Any disorder which reduces the body’s immunity, such as HIV infection or radiotherapy, could increase the risk of developing LP in the mouth.
It is thought also that there may be a genetic factor at work as far as predisposition to lichen planus is concerned, although it’s apparently uncommon for more than one member of a family to be affected.
As well as the mouth, lichen planus can affect other parts of the body including the nails, the scalp, the genitals, the ears, the eyes, or indeed any area of external skin or certain parts of the interior mucous membrane. If it affects the esophagus the condition can be rather more serious since it makes swallowing difficult.
How is oral lichen planus diagnosed?
Your dentist or doctor can often recognise the condition simply by the appearance, but sometimes a small sample (biopsy) of an affected area is taken for analysis. Sometimes allergy testing might be required.
A gauze or cotton swab may be used to collect a sample of surface cells from the lining of the mouth and this can be examined under the microscope for evidence of bacterial, viral, or fungal infection which sometimes superimposes on the condition of lichen planus.
A blood test may be carried out to rule out the presence of hepatitis which can be associated with lichen planus, or lupus, which can mimic the condition.
Lichen planus is not generally serious although it can make life somewhat miserable for sufferers. It is a chronic condition which may come and go over a period of time and there is a theoretical slightly increased risk of cancer developing in the long term.
Anyone who notices changes in the mouth which are reluctant to return to normal such as white or red patches, soreness or sensitivity of the tongue or cheek lining, or a tendency for bleeding with little provocation, should consult their dentist for advice.
Oral Lichen Planus Treatment
Mild cases may cause little discomfort and thus require no treatment, except the necessity to practise careful and thorough daily oral hygiene. Removal of dental plaque on all the teeth should be meticulous but done in a careful way to avoid provoking unnecessary bleeding. A mild-tasting toothpaste with a minimum of flavourings should be used to avoid causing discomfort.
Mouthwashes too can help keep plaque down and there are some available which can help numb the mouth to relieve pain from sore areas.
Cases where there is a lot of pain or sensitivity may benefit from the use of topical corticosteroid paste on specific areas within the mouth, or of sprays, or easily dissolved pellets or lozenges.
In severe cases of oral LP it may be necessary to medicate with a short course of steroids taken as tablets, i.e. systemically. It is not advisable to continue on a long term basis with systemic steroids, however, because of adverse side effects.
Rarely it is considered appropriate for drugs to be administered to dampen down the body’s immune system, which may help reduce the effects of lichen planus, but may of course increase the risk of other problems developing. Such medication requires careful control and monitoring.
There is as yet no actual cure for LP but it is usually possible to reduce the discomfort to an acceptable level. Sometimes the condition will clear up of its own accord or go into remission for a period of time. It is more likely to reappear if the person is stressed, on a poor diet, or otherwise compromised with regard to their health.
A sufferer can do a lot to minimize the effects of lichen planus by eating well, getting sufficient sleep, and maintaining a generally healthy lifestyle without smoking or drinking excessive alcohol. Maintaining a high standard of oral hygiene helps reduce the risk of painful outbreaks and if one should occur it’s wise to avoid acidic, spicy, or very salty foods which can aggravate symptoms. Excessive stress may also be a predisposing factor so it’s best to try to avoid or minimize this.
In view of the small risk of cancerous change developing in cases of oral lichen planus, it’s wise to have a check every six months or so and the best person is probably your own dentist who would be able to spot any material changes. Your dentist will refer you to a specialist should the need arise.
When properly managed, lichen planus can be little more than a nuisance and needn’t interfere with normal everyday life to any degree.