Oral lichen planus versus oral lichenoid reaction: Difficulties in the diagnosis

Abstract

Lichen planus (LP) is a mucocutaneous disease with well-established clinical and microscopic features. The oral mucosa and skin may present clinical and microscopic alterations similar to those observed in LP, called lichenoid reactions (LRs), which are triggered by systemic or topical etiological agents. The difficulties faced to establish the differential diagnosis between the two pathologies were investigated in the literature. It was observed that the etiology of LP is still under discussion, with a tendency to self-immunity, while the etiology of LRs is related to the contact with specific agents, such as metallic restorative materials, resins, and drugs, allowing the establishment of a cause-effect relationship. In this case, the disease is caused by the antigen fixation in the epithelial cells, which are destructed by the immune system. Based on these data, protocols are suggested for this differentiation. The important role played by the integration between the clinician and the oral pathologist in the diagnostic process is highlighted. The treatment of LP comprises mainly the utilization of corticosteroids and the LR is treated by removal of the causal factor. Differentiation between the two diseases allows an effective and correct therapeutic approach.

Medications in Thai Patients with Oral Lichen Planus, Oral Lichenoid Drug Reaction and Glossitis

“…Oral lichenoid drug reaction which cause by various drugs such as Allopurinol, Carbamazepine, Chloroquine, Dapsone, Ketoconazole, NSAIDs, Propanolol, Tetracycline. 3,4 The most reliability in diagnosis of OLDR is to see the lesion resolution after withdrawal of the suspected drugs, and the reaction may recur when the patient is rechallenged with the same drug. Oral lichenoid lesion (s) of graft-versushost disease (OLL-GVHD).…”

Detection of Helicobacter pylori in Oral Lichen Planus and Oral Lichenoid Reaction

“…This might explain the higher frequency of OLPs and OLRs in the buccal mucosa, tongue, and gingiva (33)(34)(35). Additionally, Holmstrup et al found that local factors such as dental plaque and calculus worsen gingival OLPs (36).…”

Salivary IgA and IgG in oral lichen planus and oral lichenoid reactions diseases

“…[1920] Whereas restorative dental materials play an important role in the appearance of OLR,[21] and many studies have documented contact hypersensitivity to dental materials such as amalgam,[22] composite[23] and dental acrylics. [24] Additionally, other conditions such as lupus erythematosus, erythroleukoplakia, leukoplakia, and proliferative verrucous leukoplakia may present clinical and histopathology characteristics similar to oral lichen planus.…”