White Lesions II – Oral
Lichen Planus
Dr. Rupak Sethuraman
Specific learning objectives
To learn the etiopathogenesis of oral
lichen planus.
 To
learn
the
clinical
features,
investigations and treatment for oral lichen
planus.

Format
Introduction
 Etiopathogenesis
 Clinical features
 Investigations
 Treatment

Introduction

Oral Lichen Planus (OLP/LP)
 A chronic
inflammatory disease that causes bilateral
papules, striations or plaques
 May cause erythema, erosions and blisters
 Found on buccal mucosa, tongue and gingiva
 Female: Male ratio: 1.4:1
 Mainly seen in adults over 40 years.
Etiopathogenesis

Purely T lymphocyte mediated inflammatory response.

T lymphocytes cause destruction of keratinocyte cells.
Types of Lichen Planus
1.
2.
3.
4.
5.
6.
Reticular lichen planus
Papular lichen planus
Plaque type lichen planus
Erosive lichen planus
Atrophic lichen planus
Bullous lichen planus
Clinical Presentation

Reticular lesions
 Most
common type
 Interlacing white keratotic lines called
Wickham’s striae
 Typically bilaterally on buccal mucosa,
mucobuccal fold and gingiva
 Less common on tongue, palate and lips
 Assymptomatic
Clinical Presentation

Erosive lesions





2nd most common type
Mix of erythematous and
ulcerated areas surrounded
by radiating keratotic striae
Similar appearance to
candidiasis.
Mostly buccal mucosa and
vestibule and tongue
Symptomatic:


Sore mouth sensitive to
heat, cold and spices
Pain and bleeding on
touch
2 Plaque lesions :
Resemble focal
leukoplakias
 Vary from smooth flat
areas to raised
irregular plaques
 Often multifocal
 Dorsum of tongue and
buccal mucosa

INVESTIGATIONS
Clinical examination: for reticular LP with
characteristic appearance of Wickham’s
striae or annular pattern on erythematous
background
 Histological and Direct Immunofluorescent
examinations: for plaque and erosive LP
because they can resemble other mucosal
lesions including malignancy

Treatment of OLP

Goal:




Eliminate exacerbating factors



Repair defective restorations or prosthesis
Remove offending material causing allergy
Diet



Reduce painful symptoms
Resolution of oral mucosal lesions
Reduce risk of oral squamous cell carcinoma
Eliminate smoking and alcohol consumption
Eat fresh fruit and vegetables
Reduce Stress
Treatment of OLP

Medication
 Topical
corticosteroids
0.05% clobetasol proprionate gel
 0.1% or 0.05% betamethasone valerate gel
 0.05% fluocinonide gel
 0.05% clobetasol butyrate ointment
 0.1% triamcinolone acetonide ointment

 Can
be applied directly or mixed with Orabase
Treatment of OLP

Medication
 Systemic

Prednisone (for 70kg adult)





1mg/kg/d for 6-8 weeks
Methylprednisolone


10-20mg/day for moderately severe cases
As high as 35 mg/day for severe cases
Should be taken in the morning to avoid insomnia
Should be taken with food to avoid peptic ulceration
Azathioprine – Inhibits synthesis of DNA


Steroid Therapy
to reduce pain and inflammation
Prophylactic use of 0.12% chlorhexidine gluconate may help
reduce fungal infection during corticosteroid therapy
Alternative Treatment of OLP
0.1% topical tacrolimus ointment 2
times/day
 Tacrolimus: immunosuppresive macrolide

 Suppresses
T-cell activation
Intraoral ulceration resolved after 3
months of daily application
 Remission for 1 year without maintenance


Thank you

Any questions???