Oral Lichen Planus

Diagnosis

Diagnosis of oral lichen planus is based on a detailed evaluation of your symptoms, medical history, and clinical examination. Your healthcare professional may consider several factors before confirming the diagnosis.

The diagnostic process may include:

• Discussion about your medical and dental history and the medications you’re currently taking

• Examination of your mouth and, if needed, other parts of your body to look for related signs

• Review of your symptoms, such as pain, burning sensations, or changes in the appearance of your oral tissues

Your healthcare provider may also order laboratory tests to confirm the diagnosis or rule out other conditions. These may include:

• Biopsy: A small tissue sample is taken from the affected area in your mouth and examined under a microscope. This helps confirm oral lichen planus and identify immune system proteins often associated with it.

• Cultures: A cotton swab sample from your mouth may be checked for bacterial, viral, or fungal infections that can occur alongside oral lichen planus.

• Blood tests: These may help detect underlying conditions such as hepatitis C or lupus, which can sometimes resemble or be related to oral lichen planus.

Treatment

Oral lichen planus is a chronic condition that may come and go over time. While mild cases can resolve on their own, treatment focuses on relieving symptoms and managing inflammation to improve comfort and prevent complications.

If your symptoms are mild and limited to white, lacy patches in the mouth without pain, you may not need treatment. For more severe cases, your healthcare professional may recommend one or more of the following approaches.

Symptomatic treatment

For painful areas, topical numbing agents can be used to provide short-term relief. These are especially useful for localized discomfort.

Corticosteroids

Corticosteroids are the most common treatment option to reduce inflammation and relieve symptoms. They may be given in several forms:

• Topical treatments, such as mouthwash, ointments, or gels applied directly to the affected area (preferred method)

• Oral medications, taken as pills for a limited period

• Injections, given directly into severely affected areas

Side effects depend on the method used, so discuss the risks and benefits with your healthcare provider.

Immune response medicines

For people with more severe symptoms, medicines that affect the immune system may help. These include:

• Topical immunosuppressants: Ointments or gels like tacrolimus (Protopic) or pimecrolimus (Elidel) can help control inflammation and pain. These are commonly prescribed despite an FDA warning about a possible link with cancer.

• Systemic immunosuppressants: For widespread or resistant oral lichen planus affecting multiple areas, systemic medications may be used, balancing the potential risks and benefits.

Because steroid use and immunosuppressants can lead to yeast overgrowth, regular checkups are important to identify and treat any secondary infections early.

Dealing with triggers

If your oral lichen planus appears to be linked to specific triggers, managing those can help control symptoms. Your healthcare provider may suggest:

• Switching medications that may be causing irritation

• Consulting an allergist or dermatologist for allergy testing

• Using stress management techniques, as stress can worsen flare-ups

Regular follow-ups with your healthcare provider are essential for monitoring the condition, adjusting treatment, and preventing complications.