Oral Lichen Planus (OLP)

 

- It's an inflammatory condition that affects mucous membranes inside your mouth.

- It may appear as white, lacy patches; red, swollen tissues; or open sores, and These lesions may cause burning, pain or other discomfort.

Etiology:
It's an autoimmune condition that is mediated by the T-Lymphocyte that attacks the stratified squamous epithelium which leads to hyperkeratosis with erythema or striations.
While the lichenoid eruptions are some unwanted reactions to some drugs.

Causes:
The main cause is still unknown, where the pathogen is still not fully involoved, but it may be:
1- allergic reactions to medications for high blood pressure, heart disease and arthritis, in such cases termed drug-induced lichenoid reactions.
2- complication of chronic hepatitis C virus infection.
3- a sign of chronic graft-versus-host disease of the skin (Lichenoid reaction of graft-versus-host disease)
4- true lichen planus may respond to stress.
5- Reactions to amalgam fillings may contribute to the oral lesions very similar to lichen planus
6- can be part of Grinspan's syndrome, alopecia areata, dermatomyositis, lichen sclerosis et atrophicus, morphea, myasthenia gravis, primary biliary cirrhosis, ulcerative colitis, and vitiligo.

Clinical Picture:
Affecting most commonly the females >40 years old and the children.
It's Bilaterally symmetrical.
Appears in the Buccal mucosa, lateral aspect of the tongue and Gingiva.
Appears as white striations, white papules, white plaques, erythema, erosions or blisters.

Clinical Patterns:
- Reticular Pattern
- Papular Pattern
- Plaque-like Pattern
- Erosive Pattern
- Atrophic Pattern
- Bullous Pattern

Appearance:
1- Lacy, white, raised patches of tissues, OR
2- Red, swollen, tender patches of tissues, OR
3- Open sores.

Location:
1- Inside of the cheeks, the most common location (Bilateral)
2- Gums
3- Tongue
4- Inner tissues of the lips
5- Throat
6- Esophagus

Histology:
- Hyperkeratosis, Elongated Rete Pigs, Saw-tooth Appearance, Prominent Glandular-cell appearance, Acanthosis and basal cell liquefaction.
- Lymphocytes Located just beneath the epithelium

Other signs or symptoms:
- A metallic taste or a blunted taste sensation if the tongue is affected
- Dry mouth
- Difficulty swallowing if the throat or esophagus is affected
- Sensitivity to hot or spicy foods
- Bleeding and irritation with tooth brushing

Other types of lichen planus:
1- Skin: Lesions usually appear as purplish, flat-topped bumps that are often itchy.
2- Genitals: Lesions on external genitalia resemble those affecting the skin. Lesions affecting the mucous membrane of the vagina resemble those affecting the mouth.
3- Scalp: When skin lesions appear on the scalp — a rare condition — they may cause temporary or permanent hair loss.
4- Nails: Lichen planus of the toenails or fingernails, also rare, may result in ridges on the nails, thinning or splitting of nails, and temporary or permanent nail loss.

Infection and Recurrence:
- Oral lichen planus can't be passed from one person to another.
- It tends to be a recurrent disease in teenagers and adults varying from one person to another, and are thought to be triggered by exposure to sunlight, febrile diseases, physical and psychogenic trauma, and other irritants.
- Patients who suffer recurrent intraoral herpes are few, tend to occur as vesicles followed by small ulcers, mainly on the hard palate mucosa and often follow trauma to the area, such as palatal injections or periodontal therapy.

Treatment:
- This is a chronic condition that is somehow difficult to manage, but, we should make our best to heal lesions and to lessen pain or other discomfort.
 - Drugs that are used are: Corticosteroids, Retinoids, Nonsteroidal ointments and Addressing triggers.

- Corticosteriods: To reduce the inflammation, but increases the side-effects that are to be managed, for example:
if the corticosteroids are given topically, then increases the risk of oral thrush, so that anti-fungal medication are to be prescribed to the patient, although, Long-term use of topical corticosteroids may also cause suppression of adrenal gland function and a lessening of the treatment effect.
if the corticosteroids are given orally, then the long-term use can cause weakening of the bones (osteoporosis), diabetes, high blood pressure, high cholesterol and other serious side effects.
 if the corticosteroids are given in Injections, then administered directly into lesions and repeated use can cause some of the same side effects as oral corticosteroids.

- Retinoids: are synthetic versions of vitamin A that can be applied as a topical ointment or taken orally. The topical treatment doesn't cause the same side effects associated with corticosteroids, but it may irritate the mucous membranes of your mouth. Retinoids should not be given to pregnant females and who are planning to be pregnant in the near future.

- Nonsteroidal ointments: Examples of these topical medications include tacrolimus (Protopic ointment) and pimecrolimus (Elidel cream)

- Addressing triggers: That it might be related to other causes such as Drugs, Hepatitis C, Stress and Allergen.
if related to Drugs: then stop the drug or use an alternative.
if related to Hepatitis C: then should be referred to infection or liver specialists.
if related to Stress: then should be referred to a psychotherapist, psychiatrist or other specialist in mental health car.
if related to Allergen: then should be advised to avoid the allergen, and may need to see a dermatologist or an allergist for additional treatment.

Prognosis:
- The disease may last for years, few patients with oral lesions experience spontaneous remission.
- Topical drugs provide relief but not a cure. Systemic steroids are effective but there is the risk of adverse effects and the disease may recur following discontinuance of therapy.

Differential Diagnosis:
- Squamous Carcinoma (dysplasia) "DSCQ"
- Lupus Erythematosus "SLE"
- Benign Mucous Membrane Pemphigoid "BMMP"
- Candidiasis
- Lichenoid Drug Eruptions.

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This Article is authored by :: World Of Dentistry :: TEAM

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:: World Of Dentistry :: TEAM