Update On Oral Lichen Planus: Etiopathogenesis and Management

Abstract

Lichen planus (LP) is a relatively common disorder of the stratified squamous epithelia, which is, in many ways, an enigma. This paper is the consensus outcome of a workshop held in Switzerland in 1995, involving a selection of clinicians and scientists with an interest in the condition and its management. The oral (OLP) eruptions usually have a distinct clinical morphology and characteristic distribution, but OLP may also present a confusing array of patterns and forms, and other disorders may clinically simulate OLP. Lesions may affect other mucosae and/or skin. Lichen planus is probably of multifactorial origin, sometimes induced by drugs or dental materials, often idiopathic, and with an immunopathogenesis involving T-cells in particular. The etiopathogenesis appears to be complex, with interactions between and among genetic, environmental, and lifestyle factors, but much has now been clarified about the mechanisms involved, and interesting new associations, such as with liver disease, have emerged. The management of lichen planus is still not totally satisfactory, and there is as yet no definitive treatment, but there have been advances in the control of the condition. There is no curative treatment available; immunomodulation, however, can control the condition. Based on the observed increased risk of malignant development, OLP patients should be offered regular follow-up examination from two to four times annually and asked to report any changes in their lesions and/or symptoms. Follow-up may be particularly important in patients with atrophic/ulcerative/erosive affections of the tongue, the gingiva, or the buccal mucosa. Much more research is required into the genetic and environmental aspects of lichen planus, into the premalignant potential, and into the possible associations with chronic liver, and other, disorders. More clinical studies are required into the possible efficacy of immunomodulatory drugs such as pentoxifylline and thalidomide.

Expression of αvβ6integrin in oral leukoplakia

“…Furthermore, we observed that epithelial cells in most of the lichen planus specimens also expressed α v β 6 integrin. The frequency of malignant change in lichen planus ranges from 0.4 to 3.3% (Scully et al, 1998). It is likely therefore that expression of α v β 6 integrin in lichen has no association with malignant transformation.…”

Analysis of a possible association between oral lichen planus and drug intake. A controlled study

“…One possible explanation for this difference is that, routinely, more women (64.5%) than men (35.5%) come to our clinic for a diagnosis of some type oral mu- (3,9,17). Two studies have shown a complete identification of NSAIDs as LDR inducers, with case history strongly suggesting a relationship between NSAID intake and the onset of OLP, with complete resolution or marked improvement of the lesions when these drugs were withdrawn as well as recurrence when patients were again given the offending drug (9,10).…”

“…Oral lichen planus (OLP) affects from 0.1 to about 4% of individuals, occurring mostly in middle-aged adults, with a female predominance at a ratio of approximately 2:1 (3,4). Several studies have suggested a possible relationship between OLP and daily intake of medicine (3,(5)(6)(7).…”

Clinical and Genetic Aspects of Oral Lichen Planus

“…48 OLP has been found to be associated with various viral agents such as human papilloma virus (HPV), Epstein Barr virus (EBV), human herpes virus 6 (HHV-6) and human immunodeficiency virus (HIV). [55][56][57] Epidemiological evidences from various studies worldwide strongly suggest that hepatitis C virus (HCV) may be an etiologic factor in OLP.…”