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What is Lichen Planus?

Lichen planus is a chronic disease which can appear in the mouth and on the skin. Some patients will have both mouth and skin lesions, and occasionally women may develop vaginal lesions. The lesions may disappear spontaneously, only to reappear after they seemingly have gone into remission.

How Does Oral Lichen Planus Appear?

The lesions of lichen planus occur in different forms and the appearance may vary at times. They may appear as white, slender, radiating lines or they may be red and ulcer-like at times. Lichen planus often is characterized by white, interconnecting lines called striae, which resemble the pattern of the lichen plant which grows on rocks. However, the disease has no connection to the plant lichen. Some patients are aware that they have symptoms of lichen planus, while other patients may not know of its existence until the dentist or dental hygienist brings it to their attention.

Who Gets Lichen Planus?

Lichen planus affects about 2% of the population. and the disease is seen slightly more often in women. Lichen planus usually occurs in adults with an average age of 56 years.

Is Lichen Planus Contagious?

No. Lichen Planus was first reported in 1869 and there have been no reported cases of the disease being transmitted from one person to another.

Is Lichen Planus Inherited?

No.There is little evidence to indicate that the disease runs in families.

Is Lichen Planus a Fungus?

No.Some cases of lichen planus may involve a separate fungal disease called candidiasis. Some studies have shown a higher incidence of candidiasis in patients with lichen planus. Candidiasis may be treated with antifungal medications.

How Long Will I have Lichen Planus?

The duration or severity of the disease is not predictable. Some patients have lichen planus for many years and other patients find the disease will disappear after a few months and may or may not recur.

Does Lichen Planus Cause Cancer?

No.Lichen planus does not automatically lead to cancer. If you have had a biopsy and a pathologist has reported that the lesion is lichen planus, you can be sure that you do not have cancer in that site. However, it is important to attempt to control or eliminate the disease, and additional biopsies may be necessary occasionally to check for any potential tissue changes.

What Can I Do To Control the Lichen Planus?

If the lesions are ulcerative or painful, medications such as topical steroids are often prescribed. Patients have found it helpful to keep a diary or log of factors that they feel may trigger outbreaks such as certain spicy or citrus foods, flavoring agents (such as peppermint or cinnamon), stressful events or trauma. Often no medication is necessary unless you have pain or burning.

A few studies have reported significant improvement in patients who have regular professional cleaning of the teeth and are conscientious with their home care. Patients have also reported fewer ulcerations and less sensitivity when they use milder toothpastes instead of tarter control products.

*Based on data collected from The Lichen Planus Study Interviews and Survey, at The University Of North Carolina School Of Dentistry, January 1995. Drs. Burkhart, Burkes and Burker.

Modified from: Burkhart N.W., Burkes EJ, Burker E.J. General Dentistry “Meeting the educational needs of patients with oral lichen planus.” 1997, 45:2, 126-132.

Please email questions or comments to Dr. Nancy Burkhart.

What are the facts of OLP?

  • It is a disease of unknown cause, but it may sometimes represent an allergic reaction.
  • It affects about 1% – 2% of the general population.
  • It occurs in women more than men.
  • It occurs more often in individuals past the age of 50.
  • It can occur on the skin or genitalia and in the oral cavity.
  • In the mouth it can occur in six different forms, ranging from lacy-white streaks, to white plaques, to eroded ulcers.
  • The white lesions of lichen planus are usually painless.
  • The eroded lesions usually burn and can be quite sore.
  • The gums are often affected, causing the surface of the gum tissue to peel off and leaving the gums red and raw.
  • Sometimes it appears to represent a reaction to medications, some filling materials, dental hygiene products, chewing gum, candy or other substances that touch mouth tissue.
  • Stress may play a role in outbreak of the sores.
  • Lichen planus may come and go, but it often can remain present for years if not treated.

What to do if you think you may have oral lichen planus?

  1. See your dentist and obtain a biopsy if indicated. He or she can do this for you or refer you to someone who can.
  2. Keep notes about the condition. When did it start? What medications are you taking? Did it start about the time you began a new medication? Did it start when you began using a new toothpaste or mouth rinse? Did you have dental work done shortly before it started? Does it tend to come and go?
  3. Evaluate your personal and work situation regarding stress. If you are under stress are there steps you can take to reduce it?

What to do if you have lichen planus?

  • Talk with your dentist or physician about treatment. Strong topical corticosteroids are often quite beneficial.
  • Ask your dentist or physician to be observant for signs of oral yeast infection. Sometimes the use of topical corticosteroids will change the mouth environment enough for that to become a problem. Occasionally one needs an anti-yeast medication as a preventive while using strong topical or systemic corticosteroids.
  • Maintain good oral hygiene but be careful about brushing too hard. Sometimes you can brush away the surface of the gum tissue where you have sores. Electric or sonic toothbrushes may be a bit too irritating to use until your gums are free of lichen planus sores.
  • While your mouth is too sore to brush well, consider an effective anti-plaque mouth rinse which is low in alcohol and which does not burn when you use it. Be careful with this there are a lot of mouth rinses which don’t burn but which also don’t do much to reduce plaque. The best ones for someone with a sore mouth contain a substance named “chlorhexidine,” but a prescription is required to obtain them. Unfortunately, they contain a low percentage of alcohol. If the mouth rinse burns when you use it STOP using it even if you have to do without a mouth rinse.
  • Avoid dental hygiene products and foods that burn in your mouth. Do not use alcoholic beverages or mouth rinses with a high alcohol content. Do not use products which contain hydrogen peroxide.
  • While your mouth is sore, you should have your teeth professionally cleaned fairly often, usually about every two months. Sometimes that will make your gums worse for a few days, but in the long run it will help keep them as healthy as possible. If your gums are affected with lichen planus, it may be better to ask your dentist or dental hygienist to avoid using some of the newer professional tooth cleaning devices (ultrasonic or sonic scalers) because they vibrate and may disrupt the surface tissue of your sore gums.
  • Once you have lichen planus, you should be periodically examined by your dentist or physician so they can keep an eye on you and detect any other mouth changes that may occur.
  • If your lichen planus does not improve with topical medications and if you’re taking medications for a chronic illness or disorder, ask your physician to consider an alternative medication as a trial to see if your mouth lesions are drug-induced.
  • Talk with others who have lichen planus and find out about things which may work for them.