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Oral lichen planus: Management and prognosis

Authors
Ginat W Mirowski, DMD, MD
Bethanee J Schlosser, MD, PhD
Section Editor
Robert P Dellavalle, MD, PhD, MSPH
Deputy Editor
Abena O Ofori, MD

INTRODUCTION

Oral lichen planus (oral LP) is a mucosal subtype of LP that presents with a variety of clinical features. Patients may develop reticular oral LP (white papules and plaques), erythematous (atrophic) oral LP (mucosal atrophy and red patches), and/or erosive oral LP (erosions or frank ulcers) (picture 1A-C). Although reticular LP is usually asymptomatic, pain typically accompanies the erythematous and erosive forms of oral LP. The discomfort associated with these last two clinical subtypes is the reason why many patients seek treatment.

The management and prognosis of oral LP will be reviewed here. The diagnosis of oral LP and information on other manifestations of LP are discussed separately. (See "Oral lichen planus: Pathogenesis, clinical features, and diagnosis" and "Lichen planus" and "Vulvar lichen planus" and "Lichen planopilaris" and "Overview of nail disorders", section on 'Lichen planus' and "Lichenoid drug eruption (drug-induced lichen planus)".)

APPROACH TO TREATMENT

Since there is no cure for oral LP, the primary goals of treatment are the alleviation of associated symptoms and the minimization of scarring from erosive lesions. Patients with asymptomatic reticular oral LP do not require treatment.

Oral LP is managed with a combination of nonpharmacologic and pharmacologic measures, with some variability in the therapeutic approach based upon patient-specific factors (eg, disease extent, tolerance to treatment, comorbid disease) and treatment availability. In general, local therapy is preferred over systemic therapy to minimize the risk of serious adverse effects related to treatment.

Topical corticosteroids are the first-line local treatment; additional options for local therapy include topical calcineurin inhibitors and intralesional corticosteroid injections. Systemic therapy is primarily reserved for patients who fail to respond sufficiently to local therapy or for patients with both oral LP and extraoral mucosal involvement.

                        

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Literature review current through: Nov 2016. | This topic last updated: Wed Jan 27 00:00:00 GMT+00:00 2016.
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