Skip to main content

Main menu

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • Classified ads
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • Classified ads
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Practice

Oral lichen planus

Amr F. Hamour, Hagen Klieb and Antoine Eskander
CMAJ August 04, 2020 192 (31) E892; DOI: https://doi.org/10.1503/cmaj.200309
Amr F. Hamour
Department of Otolaryngology — Head and Neck Surgery (Hamour, Eskander), University of Toronto; Department of Dentistry (Klieb), Sunnybrook Health Sciences Centre, Toronto, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Hagen Klieb
Department of Otolaryngology — Head and Neck Surgery (Hamour, Eskander), University of Toronto; Department of Dentistry (Klieb), Sunnybrook Health Sciences Centre, Toronto, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Antoine Eskander
Department of Otolaryngology — Head and Neck Surgery (Hamour, Eskander), University of Toronto; Department of Dentistry (Klieb), Sunnybrook Health Sciences Centre, Toronto, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Tables
  • Related Content
  • Responses
  • Metrics
  • PDF
Loading

The oral cavity is commonly the first site of presentation for lichen planus

Lichen planus is an immune-mediated inflammatory condition leading to characteristic lesions on skin and mucous membranes. It presents in up to 5% of the general adult population with a female predilection (2:1); the onset is most commonly in middle age.1,2 Up to 77% of patients with lichen planus have oral disease, with buccal mucosa the most common subsite.2 The oral lesions may be asymptomatic, although a subset of patients have pain and difficulty tolerating certain foods (e.g., acidic, spicy) and toothpaste.2

Oral lesions may undergo malignant transformation

Although oral lichen planus is a benign disorder, 1.4% of oral cavity lesions undergo malignant transformation within 7 years.3 Risk factors for malignant transformation include ulceration, location on the tongue and female sex.3

Some variants of oral lichen planus may resemble premalignant lesions such as erythroplakia and leukoplakia

The reticular form of oral lichen planus manifests with characteristic striated, lacy hyperkeratosis (Figure 1). However, other variants may have erythema (atrophic form) or ulceration (erosive form).4 The characteristic erythema of the atrophic form may be misinterpreted as erythroplakia, although the latter is often a well-demarcated solitary lesion.4 The plaque form, which appears as multiple white, homogeneous elevated plaques, may be mistaken for leukoplakic lesions (Appendix 1, available at www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.200309/-/DC1).2

Figure 1:
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 1:

Classic keratotic reticular striae of the buccal mucosa in reticular-form oral lichen planus. Note that this pattern is often bilateral and symmetric.

Biopsy is reserved for noncharacteristic lesions

The diagnosis of oral lichen planus is often made based on characteristic clinical features (e.g., bilateral, symmetric striated hyperkeratosis).2 Biopsy may be necessary if there is clinical concern for dysplasia (e.g., weeks-old nonhealing ulcer) or to exclude immunobullous mimickers (e.g., mucous membrane pemphigoid).1

Symptom management is the mainstay of treatment

Asymptomatic lesions do not require treatment.2 However, annual follow-up to assess for transformation and self-resolution is warranted.2,5 For symptomatic patients, treatment involves maintaining oral hygiene; eliminating rough, jagged dental surfaces; and avoiding irritating foods. For substantial and lingering symptoms, topical corticosteroids (e.g., triamcinolone) are typically used. Topical calcineurin inhibitors, intralesional corticosteroid injections and systemic agents (e.g., prednisone) are reserved for recalcitrant cases.5

Footnotes

  • Competing interests: Antoine Eskander reports receiving research funds from Merck and consulting fees from Bristol Myers Squibb in 2019. No other competing interests were declared.

  • This article has been peer reviewed.

  • The patient has given written consent for the photograph to be used.

References

  1. ↵
    1. Cheng YS,
    2. Gould A,
    3. Kurago Z,
    4. et al
    . Diagnosis of oral lichen planus: a position paper of the American Academy of Oral and Maxillofacial Pathology. Oral Surg Oral Med Oral Pathol Oral Radiol 2016;122:332–54.
    OpenUrl
  2. ↵
    1. Alrashdan MS,
    2. Cirillo N,
    3. McCullough M
    . Oral lichen planus: a literature review and update. Arch Dermatol Res 2016;308:539–51.
    OpenUrl
  3. ↵
    1. Giuliani M,
    2. Troiano G,
    3. Cordaro M,
    4. et al
    . Rate of malignant transformation of oral lichen planus: a systematic review. Oral Dis 2019;25:693–709.
    OpenUrl
  4. ↵
    1. Warnakulasuriya S,
    2. Ariyawardana A
    . Malignant transformation of oral leukoplakia: a systematic review of observational studies. J Oral Pathol Med 2016;45:155–66.
    OpenUrlCrossRefPubMed
  5. ↵
    1. Gupta S,
    2. Ghosh S,
    3. Gupta S
    . Interventions for the management of oral lichen planus: a review of the conventional and novel therapies. Oral Dis 2017;23:1029–42.
    OpenUrl
PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 192 (31)
CMAJ
Vol. 192, Issue 31
4 Aug 2020
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Oral lichen planus
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Oral lichen planus
Amr F. Hamour, Hagen Klieb, Antoine Eskander
CMAJ Aug 2020, 192 (31) E892; DOI: 10.1503/cmaj.200309

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Oral lichen planus
Amr F. Hamour, Hagen Klieb, Antoine Eskander
CMAJ Aug 2020, 192 (31) E892; DOI: 10.1503/cmaj.200309
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • The oral cavity is commonly the first site of presentation for lichen planus
    • Oral lesions may undergo malignant transformation
    • Some variants of oral lichen planus may resemble premalignant lesions such as erythroplakia and leukoplakia
    • Biopsy is reserved for noncharacteristic lesions
    • Symptom management is the mainstay of treatment
    • Footnotes
    • References
  • Figures & Tables
  • Related Content
  • Responses
  • Metrics
  • PDF

Related Articles

  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Azathioprine-induced severe anemia potentiated by the concurrent use of allopurinol
  • Schwannoma of the tongue
  • “Superscan” in diffusion-weighted imaging with background body suppression magnetic resonance imaging
Show more Practice

Similar Articles

Collections

  • Sections
    • Five Things to Know About
  • Topics
    • Oral health
    • Otolaryngology
    • Family medicine, general practice, primary care
    • Dermatology

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions

Copyright 2021, Joule Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

Powered by HighWire