Annals and Essences of Dentistry
Open Access

Clinical Features and Contemporary Treatment Approaches of Oral Lichen Planus

Xuan Chang, Shang Wang^* and Wu Song ^*Correspondence: Shang Wang, Department of Dentistry, Fudan University, Shanghai, India, Email:

Author info »

Introduction

Oral Lichen Planus (OLP) is a chronic inflammatory condition affecting the mucous membranes of the oral cavity, characterized by a range of clinical presentations and challenging treatment considerations. This article explores the diverse clinical features of OLP and examines the evolving landscape of contemporary treatment approaches aimed at managing this complex oral pathology. Diagnosing OLP requires a combination of clinical examination, patient history and often histopathological confirmation through biopsy. The management of oral lichen planus aims to alleviate symptoms, promote lesion healing and prevent disease progression. Treatment strategies are tailored based on the clinical presentation and severity of OLP lesions.

Oral lichen planus is a variant of lichen planus, a chronic autoimmune disorder that can affect the skin, mucous membranes, nails and hair follicles. In the context of the oral cavity, OLP typically presents with distinct clinical manifestations involving the mucosa, particularly the buccal mucosa (inner cheeks), tongue, gingiva (gums) and palate. outcome.

Description

Clinical features of oral lichen planus

The clinical presentation of OLP can vary widely among individuals, with manifestations ranging from mild discomfort to significant pain and impairment of oral function. Key clinical features include:

White lacy patterns (reticular OLP): The most common form of OLP, reticular lesions appear as fine white lines or lace-like patterns on the oral mucosa. These lesions often coalesce to form larger patches and may be asymptomatic or mildly irritating.

Erosive or atrophic lesions: In erosive or atrophic OLP, the mucosal lesions present as red, raw areas with a shiny surface due to epithelial thinning or ulceration. These lesions are typically painful and prone to bleeding, especially during eating or brushing teeth.

Bullous or vesicular lesions: Less common, bullous or vesicular OLP manifests as fluid-filled blisters on the oral mucosa, which may rupture to form erosions or ulcers. These lesions are often painful and can be associated with significant discomfort.

Plaque-like thickening (hypertrophic OLP): Hypertrophic lesions of OLP appear as thickened, white patches or plaques on the oral mucosa. These lesions may mimic leukoplakia but have distinct clinical and histological features characteristic of OLP.

Gingival involvement: In some cases, OLP can involve the gingival tissues, presenting as desquamative gingivitis characterized by erythema (redness), erosions and bleeding upon probing. Gingival involvement may be associated with significant discomfort and difficulty in maintaining oral hygiene.

Diagnosis of oral lichen planus

Clinical assessment involves careful inspection of oral lesions, noting their location, size, color and morphology. Differential diagnosis may include other mucosal disorders such as leukoplakia, oral candidiasis, autoimmune blistering diseases and oral squamous cell carcinoma.

Histopathological examination of biopsy specimens is crucial for confirming the diagnosis of OLP and ruling out other potential causes of oral lesions. Characteristic histological features of OLP include band-like lymphocytic infiltrate at the epithelialconnective tissue junction, apoptotic keratinocytes (Civatte bodies) and epithelial hyperplasia with hyperkeratosis in reticular forms.

Contemporary treatment approaches

Topical corticosteroids: First-line therapy for symptomatic OLP involves the use of potent or super-potent topical corticosteroids (e.g., Triamcinolone acetonide, Clobetasol propionate). These agents reduce inflammation, alleviate pain and promote healing of erosive or symptomatic lesions. Topical corticosteroids are typically applied directly to affected areas for a specified duration under close supervision to minimize side effects.

Systemic therapy: In cases of widespread or refractory OLP, systemic corticosteroids (e.g., prednisone) may be prescribed to achieve rapid control of symptoms and inflammation. However, long-term use of systemic corticosteroids is limited due to potential systemic side effects and the risk of disease relapse upon tapering.

Topical immune suppressants: Calcineurin inhibitors such as tacrolimus and pimecrolimus have emerged as alternative or adjunctive therapies for OLP. These agents inhibit T-cell activation and cytokine production, offering a steroid-sparing option for patients with chronic or recurrent disease.

Phototherapy: Narrowband Ultraviolet B (UVB) phototherapy has shown promise in treating refractory cases of OLP, particularly erosive variants. UVB radiation suppresses inflammatory responses and promotes mucosal healing, although treatment protocols and long-term efficacy require further investigation.

Oral rinses and gels: Mouthwashes containing antiseptic agents (e.g., chlorhexidine) or barrier-forming gels (e.g., hyaluronic acid) may provide symptomatic relief and support mucosal healing in patients with erosive or ulcerative OLP.

Surgical management: Surgical interventions such as laser ablation or excision of hypertrophic or symptomatic OLP lesions may be considered in selected cases to alleviate pain, improve oral function and facilitate histopathological diagnosis.

Patient education and follow-up: Education on proper oral hygiene practices, dietary modifications (e.g., avoidance of spicy or acidic foods) and stress management techniques is essential in managing OLP and preventing disease exacerbations.

Challenges and future directions

Despite advancements in understanding and management, challenges persist in the treatment of oral lichen planus.Variability in disease presentation, unpredictable treatment responses and potential for disease recurrence underscore the need for personalized therapeutic approaches and ongoing research efforts.

Future directions in OLP research include exploring novel immunomodulatory agents, targeted therapies based on disease pathogenesis and biomarkers for predicting treatment response. Multicenter clinical trials and collaborative efforts are essential to validate emerging therapies, optimize treatment algorithms and improve outcomes for patients affected by this chronic inflammatory disorder.

Conclusion

Oral lichen planus presents clinicians with a diagnostic and therapeutic challenge due to its diverse clinical manifestations and chronic nature. A tailored approach integrating clinical assessment, histopathological confirmation and evidence-based treatment strategies is essential in managing OLP effectively and improving patient quality of life.

Contemporary treatment approaches for OLP aim to alleviate symptoms, promote lesion healing and prevent disease progression through a combination of topical corticosteroids, immune suppressants, phototherapy and supportive care measures. Ongoing research and collaborative efforts hold promise in advancing our understanding of OLP pathogenesis and refining therapeutic interventions to meet the evolving needs of patients worldwide.

By raising awareness of the clinical features and contemporary treatment approaches of oral lichen planus, healthcare providers can enhance early recognition, facilitate timely intervention and optimize outcomes for individuals affected by this complex oral mucosal disorder.