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What is Oral Lichen Planus?

Lichen planus is a disease that can affect the skin and any lining mucosa. This could be the oral, esophageal, vaginal mucosa as well as the skin. Often, it is found only in the oral cavity. Overall, lichen planus affects approximately 2 percent of the population. Although the disorder may occur in all age groups, women over the age 50 years are most commonly affected.

Cause

The cause of lichen planus is not completely understood, but genetics and immunity may be involved. Findings suggest that the body is reacting to an antigen (i. e. an allergic type reaction) within the surface of the skin or mucosa. Some authorities think that lichen planus is an autoimmune disorder in which the skin cells lining the mouth are attacked by the white blood cells, but more research is needed. Others classify lichen planus as a cell-mediated immune response and believe that since a specific antigen has not been identified, it is premature to classify the disorder as autoimmune.

Appearance in the mouth

Lichen planus can appear in the mouth in several different patterns. The reticular pattern (see right) is commonly found on the cheeks as lacy web-like, white threads that are slightly raised. These lines are sometimes referred to as Wickham’s Striae. The name lichen comes from a plant that is often seen growing on rocks with its mossy, web-like appearance.

The erosive (atrophic) pattern can affect any mucosal surface, including the cheeks, tongue, and gums (see left). This form often appears bright red due to the loss of the top layer of the mucosa in the affected area. In most instances, individuals with erosive lichen planus are uncomfortable when eating and drinking, particularly with extremes of  temperature, acidic, coarse, or spicy foods.

Lichenoid reactions are instances of mucosal disease that resemble lichen planus both clinically and microscopically, but are due to an allergic response (see Right). The list of potential offending agents is extensive and includes medications, oral hygiene products and occasionally, metallic filling materials placed by your dentist. Identifying the underlying cause of a lichenoid reaction is often challenging, but when successful leads to lesion resolution.

The severity and subsequent disability caused by lichen planus varies from inconsequential to severe. Skin lesions are typically present as a purple to brown in color, raised rash that can be very itchy (see Left). In addition to the oral mucosa, other mucosal surfaces such as the eyes, esophagus, and genitalia may be affected.

(01/13/2021)
by AAOM

More Information: https://www.aaom.com/oral-lichen-planus

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