Lichen Planus

What is lichen planus?  Lichen planus is a skin disease that frequently affects the mucous membranes inside the mouth.

What causes lichen planus?  No one knows what causes lichen planus.  It is not an infection.  You didn't catch it from someone, nor can you give it to someone else.  It is not inherited.  It was not passed down from your parents, nor can you pas it on to your own children.  Lichen planus is one of a group of inflammatory diseases that affect skin and mucous membranes.  It is the inflammation in lichen planus which causes all of the problems associated with the disease.

Who gets lichen planus?  Lichen planus is twice as common in women as men and usually begins around the time of menopause.  It can begin, however, in young adults as well as senior citizens.

What does lichen planus look like?  Lichen planus has many different forms.  The most common type has white streaks and patches on the cheeks, tongue, or gums.  Another type has blisters and ulcers.  A third form simply has extensive reddening of the oral tissues.  Often more than one form is present.

How o I know if I have lichen planus?  One of the problems with lichen planus is that it can resemble a number of other conditions and vice versa.  These conditions range from canker sores to cancer.  The only way to tell for sure whether or not a patient has lichen planus is to do a biopsy and examine the tissue with a microscope.

What is involved in a biopsy?  A biopsy involves the removal of a small piece of tissue from your mouth.  This is usually done in the office rather than the hospital.  First, a small amount of anesthetic us used to numb the area.  The specimen removed is usually so small that a stitch is often not even required.  Most patients do not require any pain medication following this type of biopsy, although some prefer to take two non-aspirin tablets before going to bed.

What will happen to the biopsy specimen?  The biopsy specimen will be processed and made into slides which can be looked at under the microscope.  Depending on the particular situation, one or more stains are used to demonstrate the specific types of cells and changes present which would indicate that a patient has lichen planus or some other disease.  Once the diagnosis is made, an appropriate type of treatment can be started.

How is lichen planus treated?  Because lichen planus has many different forms, it is treated in many different ways.  In many cases, if a patient's lichen planus does not have any symptoms associated with it, nothing is done other than to monitor the disease periodically, usually twice a year.  Lichen planus is an inflammatory disease; therefore, those cases that are symptomatic are usually treated with anti-inflammatory medication.  Other medications may also be used to treat the discomfort associated with the disease.

What sorts of anti-inflammatory medications are used to treat lichen planus?  The most common medications used to treat lichen planus are steroids.  Most of the time these are applied topically to minimize the incidence of side effects from the medication.  These topical medications are applied either as a gel to be massaged into the lesions or a rinse to be swished in the mouth.  Occasionally, individual lesions that do not respond to topical medication are injected with steroids.  In severe cases, high doses of steroids are given in liquid or pill form.  Lichen planus frequently affects only the gums and interferes with a patient's ability to brush and floss.  In such cases, appliances are made to hold medication next to the gums.  These appliances are usually worn at night.  Not only does this method of treating lichen planus of the gums work well, it also makes it easier for patients to brush and floss as they would like to do.  Because lichen planus has so many forms and patients respond differently to various medications, the treatment has to be individualized in each case.

Does lichen planus cause gum disease?  Lichen planus does not cause gum disease directly; however, if lichen planus prevents you from practicing good oral hygiene because it makes your gums sore, you will get gum disease because you don't brush and floss.  Oral hygiene is extremely important in managing lichen planus; therefore, it is necessary that you make an extra effort to do everything your dentist and dental hygienist tell you to do in this regard.

How long will I have lichen planus?  Lichen planus is a chronic disease; therefore, you will have it the rest of your life.  It is not curable; however, it is certainly treatable.  There are a variety of ways to make patients comfortable that are both safe and effective.

Will lichen planus ever turn into anything else?  There is some evidence that patients with lichen planus have a slightly higher than normal risk of developing oral cancer.  This risk is extremely small, however, and certainly much less than the risk associated with tobacco use and alcohol abuse.  Nevertheless, it is important that you be reexamined on a regular basis to ensure that there are not any significant problems developing which you are not aware of.