Lichen planus is a chronic inflammatory autoimmune disease that appears on both sides of the mouth at the same time. It is not genetic or contagious. It may show up as:
White Lines, Sores, Grouped White Lesions
Lichen Planus affects about 1-2% of the adult population of the world. Females are slightly more likely to have Lichen Planus than males, and it does not discriminate. All races can be affected. It generally appears in people 40 years old or older, but can affect younger adults and children.
The patient may report a roughness of the lining of the mouth, sensitivity of the tissues of the mouth to hot or spicy foods or even toothpaste or mouthwash. Some people may not even be aware that they have Lichen Planus. They may have no symptoms from the disease other than the white patches, while other people may have very painful lesions in which the surface whiteness may erode and the lesion appears red.
Lichen Planus may arise in patients with other autoimmune disorders such as diabetes, cirrhosis, myasthenia gravis, ulcerative colitis and vitiligo. Alcohol and tobacco use may contribute to outbreaks in some patients. Some studies show a connection to infections of Hepatitis C. Also in some rare cases, it may appear as a result of an allergic response to dental materials used or ingredients in mouth rinses or toothpastes.
Outbreaks can last for many years, sometimes exhibiting no symptoms and sometimes becoming very active. During active periods, the mouth may become very sore and the patient feels like their cheeks are “thick.” Eating and homecare may become difficult due to the discomfort. Forty-four percent of the people also develop skin lesions. The skin lesions appear as flat-topped bumps that predominately show up on the insides of the wrists, elbows, knees or ankles. The itchy bumps may also be seen on the lower back and calves.
The exact cause is unknown. However, as mentioned earlier, for some, it seems to be associated with other systemic diseases.
For others, Lichen Planus may be triggered by drug reactions to NSAIDs, beta-blockers, sulfonylureas, tetracycline, Allopurinol, Lithium, oral contraceptives, Enalapril, Propranolol, Penicilin, some ACE inhibitors and some antimalairials.
Other reactions may be triggered by contact with allergens including dental amalgam, chromium, nickel, composite resins and toothpaste flavorings, especially cinnamon. The patient may opt to undergo allergy testing. If an allergy is detected, the lesions may disappear when no longer exposed to the material causing the allergy.
Other conditions under which the Lichen Planus lesions may occur are part of the graft/host response in bone marrow transplants and in times of psychological stress and anxiety.
Patients with Lichen Planus may also be at a greater risk (5%) for squamous cell carcinoma, the most common oral cancer. The risk is greater when tobacco or alcohol use is involved. A biopsy may be indicated. The patient’s condition should be monitored by a dental care professional on a six to twelve month schedule.
There is no cure, but the symptoms can be treated, usually with topical steroid preparations. Care must be taken because a secondary yeast infection may occur.
The patient may be able to ease the symptoms if the suspected cause is removed.