Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Oral lichen planus: Pathogenesis, clinical features, and diagnosis

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


Lichen planus (LP) is a chronic inflammatory disorder that affects the skin and mucous membranes. Oral LP is a mucosal subtype of LP that most commonly occurs in middle-aged adults. Oral LP may occur alone or in conjunction with other forms of LP (picture 1A-C). (See "Lichen planus", section on 'Clinical features'.)

The clinical findings of oral LP range from reticular white plaques to mucosal erythema, erosions, ulceration, and hyperkeratotic plaques (picture 2A-C). Although reticular lesions are often asymptomatic, pain frequently accompanies the other manifestations of oral LP.

The pathogenesis, clinical manifestations, and diagnosis of oral LP will be reviewed here. Discussion of the management of oral LP and reviews of other forms of LP are provided separately. (See "Oral lichen planus: Management and prognosis" and "Lichen planus" and "Lichen planopilaris" and "Vulvar lichen planus" and "Overview of nail disorders", section on 'Lichen planus' and "Lichenoid drug eruption (drug-induced lichen planus)".)


Epidemiologic data on oral lichen planus (LP) vary. Population-based studies performed in Asia, Europe, North America, and the Middle East have found disease prevalence rates between less than 1 percent and 3 percent [1].

Oral LP most commonly occurs in middle-aged adults. Large retrospective studies from Europe and the United States indicate that the average age of patients presenting with oral LP is around 50 to 60 years [2-4]. Oral LP is rare in children [5-9].

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Jul 11, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. McCartan BE, Healy CM. The reported prevalence of oral lichen planus: a review and critique. J Oral Pathol Med 2008; 37:447.
  2. Eisen D. The clinical features, malignant potential, and systemic associations of oral lichen planus: a study of 723 patients. J Am Acad Dermatol 2002; 46:207.
  3. Carbone M, Arduino PG, Carrozzo M, et al. Course of oral lichen planus: a retrospective study of 808 northern Italian patients. Oral Dis 2009; 15:235.
  4. Bermejo-Fenoll A, Sánchez-Siles M, López-Jornet P, et al. A retrospective clinicopathological study of 550 patients with oral lichen planus in south-eastern Spain. J Oral Pathol Med 2010; 39:491.
  5. Walton KE, Bowers EV, Drolet BA, Holland KE. Childhood lichen planus: demographics of a U.S. population. Pediatr Dermatol 2010; 27:34.
  6. Kanwar AJ, De D. Lichen planus in children. Indian J Dermatol Venereol Leprol 2010; 76:366.
  7. GunaShekhar M, Sudhakar R, Shahul M, et al. Oral lichen planus in childhood: A rare case report. Dermatol Online J 2010; 16:9.
  8. Anuradha Ch, Reddy GS, Nandan SR, et al. Oral mucosal lichen planus in nine-year-old child. N Y State Dent J 2011; 77:28.
  9. Patel S, Yeoman CM, Murphy R. Oral lichen planus in childhood: a report of three cases. Int J Paediatr Dent 2005; 15:118.
  10. Hellgren L. The prevalence of lichen ruber planus in different geographical areas in Sweden. Acta Derm Venereol 1970; 50:374.
  11. Nagao T, Ikeda N, Fukano H, et al. Incidence rates for oral leukoplakia and lichen planus in a Japanese population. J Oral Pathol Med 2005; 34:532.
  12. Xue JL, Fan MW, Wang SZ, et al. A clinical study of 674 patients with oral lichen planus in China. J Oral Pathol Med 2005; 34:467.
  13. Thorn JJ, Holmstrup P, Rindum J, Pindborg JJ. Course of various clinical forms of oral lichen planus. A prospective follow-up study of 611 patients. J Oral Pathol 1988; 17:213.
  14. Roopashree MR, Gondhalekar RV, Shashikanth MC, et al. Pathogenesis of oral lichen planus--a review. J Oral Pathol Med 2010; 39:729.
  15. Salem A, Rozov S, Al-Samadi A, et al. Histamine metabolism and transport are deranged in human keratinocytes in oral lichen planus. Br J Dermatol 2017; 176:1213.
  16. Shengyuan L, Songpo Y, Wen W, et al. Hepatitis C virus and lichen planus: a reciprocal association determined by a meta-analysis. Arch Dermatol 2009; 145:1040.
  17. Carrozzo M, Brancatello F, Dametto E, et al. Hepatitis C virus-associated oral lichen planus: is the geographical heterogeneity related to HLA-DR6? J Oral Pathol Med 2005; 34:204.
  18. Carrozzo M, Francia Di Celle P, Gandolfo S, et al. Increased frequency of HLA-DR6 allele in Italian patients with hepatitis C virus-associated oral lichen planus. Br J Dermatol 2001; 144:803.
  19. Siponen M, Huuskonen L, Läärä E, Salo T. Association of oral lichen planus with thyroid disease in a Finnish population: a retrospective case-control study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 110:319.
  20. Dreiher J, Shapiro J, Cohen AD. Lichen planus and dyslipidaemia: a case-control study. Br J Dermatol 2009; 161:626.
  21. Siponen M, Kauppila JH, Soini Y, Salo T. TLR4 and TLR9 are induced in oral lichen planus. J Oral Pathol Med 2012; 41:741.
  22. El Tawdy A, Rashed L. Downregulation of TLR-7 receptor in hepatic and non-hepatic patients with lichen planus. Int J Dermatol 2012; 51:785.
  23. Janardhanam SB, Prakasam S, Swaminathan VT, et al. Differential expression of TLR-2 and TLR-4 in the epithelial cells in oral lichen planus. Arch Oral Biol 2012; 57:495.
  24. Carrozzo M, Uboldi de Capei M, Dametto E, et al. Tumor necrosis factor-alpha and interferon-gamma polymorphisms contribute to susceptibility to oral lichen planus. J Invest Dermatol 2004; 122:87.
  25. Jin X, Wang J, Zhu L, et al. Association between -308 G/A polymorphism in TNF-α gene and lichen planus: a meta-analysis. J Dermatol Sci 2012; 68:127.
  26. Schlosser BJ. Lichen planus and lichenoid reactions of the oral mucosa. Dermatol Ther 2010; 23:251.
  27. Eisen D. The clinical manifestations and treatment of oral lichen planus. Dermatol Clin 2003; 21:79.
  28. Eisen D, Carrozzo M, Bagan Sebastian JV, Thongprasom K. Number V Oral lichen planus: clinical features and management. Oral Dis 2005; 11:338.
  29. Scully C, el-Kom M. Lichen planus: review and update on pathogenesis. J Oral Pathol 1985; 14:431.
  30. Bermejo A, Aguirre JM, López P, Saez MR. Superficial mucocele: report of 4 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999; 88:469.
  31. Eveson JW. Superficial mucoceles: pitfall in clinical and microscopic diagnosis. Oral Surg Oral Med Oral Pathol 1988; 66:318.
  32. Mergoni G, Ergun S, Vescovi P, et al. Oral postinflammatory pigmentation: an analysis of 7 cases. Med Oral Patol Oral Cir Bucal 2011; 16:e11.
  33. Eisen D. The evaluation of cutaneous, genital, scalp, nail, esophageal, and ocular involvement in patients with oral lichen planus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999; 88:431.
  34. Farhi D, Dupin N. Pathophysiology, etiologic factors, and clinical management of oral lichen planus, part I: facts and controversies. Clin Dermatol 2010; 28:100.
  35. Goettmann S, Zaraa I, Moulonguet I. Nail lichen planus: epidemiological, clinical, pathological, therapeutic and prognosis study of 67 cases. J Eur Acad Dermatol Venereol 2012; 26:1304.
  36. McPherson T, Cooper S. Vulval lichen sclerosus and lichen planus. Dermatol Ther 2010; 23:523.
  37. Mirowski GW, Goddard A. Treatment of vulvovaginal lichen planus. Dermatol Clin 2010; 28:717.
  38. Pelisse M. The vulvo-vaginal-gingival syndrome. A new form of erosive lichen planus. Int J Dermatol 1989; 28:381.
  39. Rogers RS 3rd, Eisen D. Erosive oral lichen planus with genital lesions: the vulvovaginal-gingival syndrome and the peno-gingival syndrome. Dermatol Clin 2003; 21:91.
  40. Brewer JD, Ekdawi NS, Torgerson RR, et al. Lichen planus and cicatricial conjunctivitis: disease course and response to therapy of 11 patients. J Eur Acad Dermatol Venereol 2011; 25:100.
  41. Webber NK, Setterfield JF, Lewis FM, Neill SM. Lacrimal canalicular duct scarring in patients with lichen planus. Arch Dermatol 2012; 148:224.
  42. Rennie CE, Dwivedi RC, Khan AS, et al. Lichen planus of the larynx. J Laryngol Otol 2011; 125:432.
  43. Fox LP, Lightdale CJ, Grossman ME. Lichen planus of the esophagus: what dermatologists need to know. J Am Acad Dermatol 2011; 65:175.
  44. Martin L, Moriniere S, Machet MC, et al. Bilateral conductive deafness related to erosive lichen planus. J Laryngol Otol 1998; 112:365.
  45. Agha R, Mirowski GW. The art and science of oral examination. Dermatol Ther 2010; 23:209.
  46. Eisen D. The oral mucosal punch biopsy. A report of 140 cases. Arch Dermatol 1992; 128:815.
  47. Duncan SC, Su WP. Leukoedema of the oral mucosa. Possibly an acquired white sponge nevus. Arch Dermatol 1980; 116:906.
  48. Martin JL. Leukoedema: a review of the literature. J Natl Med Assoc 1992; 84:938.
  49. Thornhill MH, Sankar V, Xu XJ, et al. The role of histopathological characteristics in distinguishing amalgam-associated oral lichenoid reactions and oral lichen planus. J Oral Pathol Med 2006; 35:233.
  50. Vargas-Díez E, García-Díez A, Marín A, Fernández-Herrera J. Life-threatening graft-vs-host disease. Clin Dermatol 2005; 23:285.