Definition and Overview

Lichen planus is a chronic inflammatory condition that affects the skin. It is referred to as oral lichen planus (OLP) when it develops inside the mouth.

The condition may only occur in the mouth or also affect other body parts at the same time. It can also occur in the genitals, nails, and scalp. The condition is marked by the onset of non-infectious, itchy rash. The rash is often small with an irregular shape. It also has a flat top and appears as pink or purple bumps. OLP affects about 1% of the population.

Causes of Condition

The cause of OLP is yet to be fully understood. Skin specialists believe that it is an autoimmune disorder. This means that the immune system attacks the healthy tissues along the linings of the mouth. OLP is also linked to a number of factors. These include certain medications, such as painkillers and malaria and tranquilising drugs. OLP is also sometimes triggered by the body’s reaction to metals placed in the mouth. Examples are dental fillings and metal braces. There have also been reports of the disorder occurring due to mouth mannerisms. Examples are biting the cheeks or tongue. Other possible causes are other mouth problems, chronic hepatitis C, and cirrhosis.

It is important to note that OLP is not an infection. It is also not contagious. It is not passed on from person to person. It is also not linked to nutrition or nutritional deficiency. However, eating certain fruits, tomato-based products, and spicy food has been found to make the symptoms worse.

OLP is more common in women than men. It is often diagnosed in patients aged 40 and above. However, it can also affect children and young adults.

Key Symptoms

OLP appears as whitish lace-like streaks on the inner surface of the tongue. It can also occur in the inner tissues of the lips, the linings of the mouth, and the palate. In some cases, it presents as red or white patches on the inside of the cheeks. It sometimes appears as an area of open sores and blisters in random areas of the mouth. When such patches affect the gums, they appear shiny and red. These lesions can persist and recur. When they do, they can affect the patient’s sense of taste.

Symptoms of lichen planus that may accompany LOP vary depending on the affected area. These include:

  • A rash that appears suddenly - The rash is often persistent and can last several weeks or months.

  • Rashes that appear as raised bumps or papules with clumps or patterns - They can be red, pink or purple.

  • Rashes that are raised but flat-topped - They are approximately 3 to 5 millimeters wide in diameter.

  • Occasional white streaks on the bumps - These are known as Wickham’s striae.

  • Rashes that are extremely itchy - The itch is often worse at nighttime.

Who to See and Types of Treatments Available

OLP is not a serious condition. In fact, mild cases do not require treatment. Often, maintaining a good oral hygiene is enough to manage it.

Treatment becomes necessary if OLP interferes with normal oral function. Patients who are unable to talk, eat, or chew properly should consult a GP or a family doctor.

To diagnose OLP, the doctor will ask about the patient’s medical and dental history. He or she will also want to know if the patient is currently taking certain medications.

The doctor will then examine the mouth and other areas. Lab tests may be used in some cases. These may include tissue culture and a blood test. A biopsy and other special tests to check for autoimmune disease are also often used. Depending on the symptoms, the doctor may need to make a referral. The patient may be asked to see a gum or skin specialist.

OLP is a chronic condition without a definite treatment. It can persist for several months. However, there are ways to lessen its symptoms. Treatment options include the following:

  • Corticosteroids - This is a staple medication for treating OLP. It comes in the form of a mouthwash, gel, or ointment that can be applied directly to the affected area. The drug can also be injected directly or taken as a pill.

  • Anaesthetic - Analgesic or anaesthetic mouthwashes are used to lessen discomfort caused by the lesions. They must be used before meals.

  • Antiseptic - Antiseptic mouthwash or gel can be used. This treatment prevents plaque buildup during times when the gums are painful and brushing is difficult.

  • Steroid lozenges - These can also be used to alleviate pain.

In severe cases of OLP, long-term medication is usually advised. This is often the case when the condition is due to an autoimmune disorder. The use of such medications requires regular monitoring. This involves regular blood examination to screen for drug toxicity. This is advised in the first few weeks of treatment.

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