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Oral Lichen Planus (OLP)

Oral Lichen Planus (OLP)

Definition:

Oral Lichen Planus (OLP) is a chronic inflammatory condition affecting the mucous membranes of the mouth. It is an immune-mediated disorder where the body’s immune system mistakenly attacks the oral tissues, leading to white, lacy patches, redness, and ulcerations. OLP is considered a potentially malignant disorder, with a small risk of transforming into oral cancer.

Causes & Risk Factors

The exact cause of OLP is unknown, but it is believed to be an autoimmune disorder. Other contributing factors include:

  • Genetic predisposition
  • Chronic stress & psychological factors
  • Allergic reactions to dental materials (amalgam, composite, etc.)
  • Certain medications (NSAIDs, antihypertensives, antimalarials)
  • Viral infections (such as Hepatitis C association in some cases)

Types of Oral Lichen Planus

OLP presents in different clinical forms:

  1. Reticular Type (Most Common)
    • White, lacy, web-like patches (Wickham’s striae)
    • Usually asymptomatic
  2. Erosive Type (Painful Form)
    • Red, inflamed areas with ulceration
    • Burning sensation, especially with spicy food
  3. Atrophic Type
    • Generalized mucosal thinning
    • Painful and sensitive to food
  4. Bullous Type
    • Fluid-filled blisters that rupture easily
  5. Plaque-like Type
    • White, raised patches similar to leukoplakia

Symptoms

  • White, lacy patches (Wickham’s striae) on the buccal mucosa, tongue, and gums
  • Burning sensation and pain, especially in erosive or ulcerative forms
  • Sensitivity to spicy or acidic foods
  • Gum inflammation (desquamative gingivitis)
  • Occasionally associated with skin lesions

Diagnosis

  1. Clinical Examination:
    • Characteristic lacy white patterns on the oral mucosa
  2. Biopsy & Histopathology:
    • Hyperkeratosis, basal cell degeneration, and band-like infiltration of lymphocytes
  3. Direct Immunofluorescence (DIF):
    • Helps differentiate OLP from other autoimmune mucosal diseases
  4. Hepatitis C Testing:
    • Some studies suggest a link between OLP and Hepatitis C infection

Treatment & Management

There is no definitive cure, but treatment aims to reduce symptoms and prevent complications.

  1. Lifestyle Modifications:
    • Avoid spicy, acidic, and hard foods
    • Quit smoking and alcohol
    • Reduce stress (yoga, meditation, counseling)
  2. Medical Treatment:
    • Topical corticosteroids (first-line treatment) – e.g., Clobetasol, Betamethasone
    • Systemic corticosteroids (for severe cases)
    • Calcineurin inhibitors (Tacrolimus, Cyclosporine) – used in steroid-resistant cases
    • Retinoids (Vitamin A derivatives) – beneficial for some patients
    • Antifungal treatment – if secondary candidiasis is present
  3. Pain Management:
    • Topical anesthetics (Lidocaine gel)
    • Antiseptic mouthwashes (Chlorhexidine)
  4. Regular Follow-up & Malignant Transformation Monitoring:
    • OLP has a 1-2% chance of transforming into oral cancer over time
    • Regular biopsies are recommended for non-healing, erosive lesions

Complications

  • Chronic pain and discomfort affecting quality of life
  • Increased risk of oral infections (candidiasis, secondary bacterial infections)
  • Potential malignant transformation (requires long-term monitoring)

Prevention & Prognosis

  • Good oral hygiene and regular dental check-ups
  • Avoidance of triggers (spicy foods, alcohol, tobacco, stress)
  • Early diagnosis and management reduce complications
  • Most cases are manageable, but long-term follow-up is essential

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