Oral lichen planus: symptoms, treatment, causes and outlook

BAD says mild cases may be symptom-free and need no treatment. For oral lichen planus that is causing discomfort, topical treatments can be used. Anaesthetic mouthwashes, such as benzydamine, are particularly helpful if used before meals. Topical steroids applied directly to affected areas in the mouth help most patients, and come as mouthwashes, sprays, pastes and small pellets (tablets) that dissolve in the mouth. The NHS lichen planus page says mouthwashes and sprays from a GP can help ease symptoms such as burning or sore gums.

If the gums are affected, BAD stresses keeping the teeth as clean as possible with regular, effective brushing, because plaque build-up can make the gum condition worse. A dentist or dental hygienist can give advice and arrange cleaning. An antiseptic mouthwash or gel may be recommended to control plaque, such as a daily hydrogen peroxide mouthwash or chlorhexidine twice per week, avoiding mouthwash containing alcohol if possible.

In severe cases, BAD says medicine taken by mouth (systemic treatment) may be required for several months or years. Oral corticosteroids may be prescribed for a few months, but long-term steroid tablets have possible side effects. Other immune-reducing medicines, including azathioprine, methotrexate and mycophenolate mofetil, are used so that the steroid dose can be reduced as soon as possible. They need regular blood tests and specialist monitoring.

BAD says that in most cases it is not known why oral lichen planus has occurred, but it is likely to be related to the body's immune system. It is not an infection and is not contagious, so it cannot be passed from person to person. Some cases may be linked to chronic hepatitis C infection, although BAD says this is uncommon in the UK. It also says that, although there may be a genetic basis, it is uncommon for more than one member of a family to be affected.

A separate group are oral lichenoid patches, which are not oral lichen planus but can be very difficult to tell apart from it. BAD says they can be caused by medicines, such as some drugs prescribed for high blood pressure and diabetes, or by dental materials (mercury, nickel, gold, resins and acrylates). The general BAD lichen planus leaflet adds that stress and anxiety and some viruses are thought to be possible triggers for lichen planus in general.

BAD lists a burning or stinging discomfort in the mouth when eating or drinking. Spicy foods, citrus fruits and alcohol may trigger these sensations. If the gums are affected they could become tender and tooth-brushing may be uncomfortable. Ulcers or erosions sometimes occur and are especially painful. About 15% of people also have lesions on the skin caused by lichen planus. Mild cases can be symptom-free.

The NHS lists white patches on the gums, tongue or insides of the cheeks, and burning and stinging in the mouth, as symptoms of lichen planus. Typically, according to BAD, oral lichen planus appears as white, lace-like patterned patches on the tongue and inner surfaces of the cheeks, with bright red and swollen areas around them. It can also show as white and red patches or areas of sores on the lining of the mouth. When the gums are affected it is called "desquamative gingivitis", and the gums look red and shiny.

BAD says a dentist or doctor may be able to make the diagnosis from the appearance of the inside of the mouth alone. Sometimes a small sample (biopsy) is taken from an affected area for examination under a microscope, using a local anaesthetic injection to numb the area. The NHS says to see a GP if you think you might have lichen planus.

These are the self-care measures given by BAD and the NHS. They do not replace treatment prescribed by a clinician.

• Avoid spicy, acidic or salty foods, or alcohol, if they make your mouth sore.

• Keep your teeth clean with a soft brush and a small interdental brush to clean between the teeth. Brush carefully twice a day.

• Choose a toothpaste with a mild flavour and free from the foaming agent sodium lauryl sulphate (SLS).

• Use a mouthwash that does not contain alcohol if alcohol makes your mouth sore.

• Stop smoking and keep alcohol within recommended limits (currently 14 units a week), as these are the main risk factors for mouth cancer.

There is no special diet for oral lichen planus in the sources read. The advice is to avoid foods that make the mouth sore. BAD and the NHS name spicy, citrus or acidic and salty foods, and alcohol, as common triggers of burning. If food is hard to eat during a flare, an anaesthetic mouthwash before meals may help (BAD). Discuss persistent eating problems or weight loss with a GP or dentist.

BAD says that in most cases oral lichen planus cannot be cured, but it may go away on its own. It tends to last longer than lichen planus affecting the skin on other parts of the body, and may persist for a number of years. The NHS says lichen planus on the skin usually gets better on its own in about 9 to 18 months, while lichen planus in the mouth can last for several years. There are treatments to manage and reduce the severity of symptoms.

In most people oral lichen planus is not serious. BAD says an important but uncommon feature is a tendency to cancerous change, with about a 1% risk over 10 years, or one in a hundred people developing cancer in the mouth. Because of that small risk, it is important to have the mouth checked regularly by a dentist or oral specialist so that any early changes can be spotted.

See a GP or dentist if you have white patches in the mouth, burning or stinging that does not settle, sore gums, ulcers or erosions that do not heal, or any change in a patch that has been there for some time. Oral lichen planus can look like other mouth conditions, and some mouth changes need to be checked to rule out more serious causes. The NHS advises seeing a GP if you think you have lichen planus.

A dentist or GP can often make the diagnosis, prescribe steroid mouthwashes or sprays, and refer you to an oral medicine or dermatology specialist if the disease is severe or the diagnosis is uncertain. BAD says systemic treatment is guided by a specialist who will explain the risks and benefits. Private dentists and consultants also see people with oral lichen planus. Whichever route you use, ask how often the mouth should be checked and who will arrange follow-up.