Oral Lichen Planus

1. See Also
   1. Cutaneous Lichen Planus
   2. Vulvar Lichen Planus
2. Epidemiology
   1. Prevalence: 1-2% in United States
   2. Age usually >40 years
   3. Gender predominance: Slightly more common in women
3. Pathophysiology
   1. Autoimmune mediated apoptosis of epithelial cells
   2. Involves CD8+ cytotoxic T-Cells
4. Signs
   1. Reticular type
      1. Distributed on posterior Buccal mucosa
      2. Asymptomatic lesions
      3. Appearance
         1. White confluent Papules or
         2. Lacelike (lichenoid) network of striations
            1. Also known as Wickham's striae
   2. Erosive type
      1. Painful erythema or ulcers
      2. Surrounded by white radiating striae
   3. Desquamative Gingivitis type (Erosive type variation)
      1. Generalized erythema or Ulceration of the Gingiva
5. Associated Conditions
   1. Hepatitis C
6. Evaluation
   1. Biopsy lichenoid lesions if not classic appearance
7. Management
   1. Asymptomatic lesions require no treatement
   2. First-Line: Topical Corticosteroids
      1. Clobetasol (Temovate)
      2. Fluocinonide
      3. Corticosteroid oral rinses
   3. Second-Line: Topical Calcineurin Inhibitors
      1. Pimecrolimus
      2. Tacrolimus
   4. Third-Line: Systemic Corticosteroids
      1. Oral Prednisone
   5. Routine surveillance
      1. May be associated with Oral Cancer risk
8. References
   1. Ismail (2007) J Oral Sci 49(2): 89-106
   2. Sugerman (2000) Clin Dermatol 18:533-9