Oral lichen planus
Overview
Oral lichen planus is a chronic autoimmune inflammatory condition affecting the lining of your mouth, usually resulting in characteristic lacy white patches. Oral lichen planus occurs most often on the inside of your cheeks but also can affect your gums, tongue, lips and other parts of your mouth. Oral lichen planus sometimes involves your throat or esophagus. While oral lichen planus usually begins during midlife, it can occur at any age. An initial episode of oral lichen planus may last for weeks or months. But unfortunately, oral lichen planus is usually a chronic condition and can last for many years. Although there's no cure, oral lichen planus can be managed with medications and home remedies.
Symptoms
* Mouth lesions o Tender or painful (mild cases may have no discomfort) o Located on the sides of the tongue or the inside of the cheek o Occasionally located on the gums o Poorly defined area of blue-white spots or "pimples" o Lines of lesions that form a lacy-looking network o Gradual increase in size of the affected area o Lesions occasionally form painful ulcers * Skin lesions: o Usually located on the inner wrist, legs, torso, or genitals o Itchy o Symmetrical o Single lesion or clusters of lesions, often at sites of skin trauma o Papule 2 - 4 cm in size o Papules clustered into a large, flat-topped lesion o Lesions have distinct, sharp borders o Possibly covered with fine white streaks or scratch marks called Wickham's striae o Shiny or scaly appearance o Dark colored -- reddish-purple (skin) or gray-white (mouth) o Possibility of developing blisters or ulcers Other symptoms include: * Dry mouth * Hair loss * Metallic taste in the mouth * Ridges in the nails (nail abnormalities)
Causes
The exact cause of lichen planus is unknown. However, it is likely to be related to an allergic or immune reaction. Risks include: * Exposure to medications, dyes, and other chemical substances (including gold, antibiotics, arsenic, iodides, chloroquine, quinacrine, quinide, phenothiazines, and diuretics) * Disorders such as hepatitis C Lichen planus generally affects middle-aged adults. It is less common in children.
Diagnosis
Frequently, your dentist is the first to notice oral lichen planus symptoms during a routine examination. The condition often can be diagnosed just by examining the affected areas of your mouth. In some cases, though, you may need to see a doctor or dentist who specializes in dermatology or oral medicine for a definitive diagnosis and treatment. To make a diagnosis, your doctor may: * Ask about your symptoms * Discuss your medical history * Examine your mouth and other areas of your body * Order tests, such as blood and allergy tests, to rule out other conditions, such as yeast infections and canker sores * Take a biopsy of your lesions, especially if they're erosive or ulcerated
Prognosis
Lichen planus is generally not harmful and may get better with treatment. However it may last for weeks to months, and may come and go for years. It usually clears up within 18 months.
Treatment
The goal of treatment is to reduce your symptoms and speed healing of the skin lesions. If symptoms are mild, you may not need treatment. Treatments may include: * Antihistamines * Immune-suppressing medications, such as cyclosporine (in severe cases) * Lidocaine mouth washes -- to numb the area temporarily and make eating more comfortable (for mouth lesions) * Topical corticosteroids (such as clobetasol) or oral corticosteroids (such as prednisone) -- to reduce inflammation and suppress immune responses. Corticosteroids may be injected directly into a lesion. * Topical retinoic acid cream (a form of vitamin A) and other ointments or creams -- to reduce itching and inflammation and aid healing * Dressings may be placed over topical medications to protect the skin from scratching. * Ultraviolet light therapy may be helpful in some cases.