Treatment Of Oral Lichen Planus

Oral Lichen Planus (OLP) is a chronic inflammatory condition affecting the mucous membranes inside the mouth. Recognizing its symptoms, understanding its causes, and seeking appropriate treatment are essential for effective management.

What is Oral Lichen Planus?

OLP is a type of lichen planus that specifically involves the oral mucosa. It presents as white, lacy patches; red, swollen tissues; or open sores inside the mouth. These lesions can cause discomfort or pain, especially when consuming certain foods or beverages.

What are the Symptoms of Oral Lichen Planus?

The manifestations of OLP vary, but common symptoms include:

• Reticular Form: Characterized by net-like white lines known as Wickham’s striae, typically asymptomatic.

• Erosive or Ulcerative Form: Painful ulcers and erosions covered with a yellow slough, often accompanied by redness.

• Papular Form: Small white pinpoint papules that are usually asymptomatic.

• Plaque-like Form: Large, homogenous white patches resembling leukoplakia, more prevalent in tobacco smokers.

• Atrophic Form: Prominent atrophic lesions on a background of erythema with radiating white striae at the margins.

• Bullous Form: Rare, characterized by fluid-filled vesicles that rupture easily, leaving painful ulcerated surfaces.

These forms often coexist, and lesions commonly appear bilaterally on the inner cheeks, tongue, gums, and other areas within the mouth.

What Causes Oral Lichen Planus?

The exact cause of OLP remains unclear, but it is believed to be an autoimmune disorder where the immune system mistakenly attacks the cells of the oral mucous membranes. Potential contributing factors include:

• Genetic Predisposition: A family history of lichen planus may increase susceptibility.

• Medications: Certain drugs, such as antihypertensives, antidepressants, diuretics, antidiabetics, and NSAIDs, have been associated with lichenoid drug eruptions that mimic OLP.

• Dental Materials: Allergic reactions to materials like dental composites or metal-based dentures can trigger oral lichenoid contact reactions.

• Infections: Hepatitis C virus infection has been linked to lichen planus in some studies.

However, in many cases, no identifiable cause is found.

How is Oral Lichen Planus Diagnosed?

Diagnosis involves a combination of:

• Medical History: Assessing symptoms, medication use, and potential exposure to allergens.

• Clinical Examination: Visual inspection of the oral cavity for characteristic lesions.

• Biopsy: A tissue sample may be taken to confirm the diagnosis and rule out other conditions.

Histopathological examination typically reveals features such as parakeratosis, saw-toothed rete ridges, and a band-like lymphocytic infiltrate beneath the epithelium.

What are the Treatment Options for Oral Lichen Planus?

Since Oral Lichen Planus (OLP) is a chronic condition with no definitive cure, treatment focuses on relieving symptoms, controlling inflammation, and preventing complications. The choice of treatment depends on the severity of symptoms, the extent of lesions, and the patient’s overall health.

1. Conventional Medical Treatments

A. Topical Corticosteroids (First-line Treatment)

Topical corticosteroids are the most commonly prescribed treatment for mild to moderate OLP. They help reduce inflammation, alleviate pain, and control lesion progression.

• Examples:

  • Clobetasol Propionate (0.05%)
  • Betamethasone Valerate (0.1%)
  • Fluocinonide (0.05%)
  • Triamcinolone Acetonide (0.1%)

• Forms of Application:

  • Gels and Ointments: Preferred as they adhere to the mucosa better than creams or lotions.
  • Mouth Rinses: Dexamethasone mouthwash (0.5 mg/5 ml) is often prescribed for widespread OLP.
  • Adhesive Pastes: These improve drug retention in the affected area.

• Side Effects:

  • Long-term use may cause fungal infections (oral candidiasis), thinning of the mucosa, and delayed healing.

B. Systemic Corticosteroids (For Severe Cases)

If topical corticosteroids fail or the OLP is widespread and severe, systemic steroids are considered.

• Examples:

  • Prednisolone (30–60 mg/day) for a short duration followed by tapering.
  • Intralesional injections of Triamcinolone Acetonide for localized but severe lesions.

• Side Effects:

  • Prolonged use can lead to weight gain, osteoporosis, diabetes, hypertension, and increased infection risk.

C. Immunosuppressive Agents (For Resistant Cases)

These are used in patients who do not respond well to corticosteroids. They help suppress the overactive immune response.

• Examples:

  • Tacrolimus (0.1%) – A topical calcineurin inhibitor that reduces inflammation.
  • Cyclosporine (Oral or Topical) – Works similarly to tacrolimus but is less commonly used due to potential kidney toxicity.
  • Azathioprine and Mycophenolate Mofetil – Reserved for severe cases requiring systemic immunosuppression.

• Side Effects:

  • Increased risk of infections, kidney and liver toxicity.

D. Retinoids (Vitamin A Derivatives)

Retinoids can help in cases that are unresponsive to steroids.

• Examples:

  • Topical Tretinoin (0.1%)
  • Oral Acitretin (10-50 mg/day)

• Side Effects:

  • Mucosal irritation, dryness, teratogenic effects (harmful in pregnancy).

E. Phototherapy (PUVA Therapy)

Phototherapy using Psoralen + Ultraviolet A (PUVA) can be beneficial in severe, widespread OLP cases.

• How It Works:

  • Psoralen makes the skin/mucosa more sensitive to UVA light, which then helps suppress the immune overreaction.

• Side Effects:

  • Risk of skin pigmentation changes, burning, and long-term cancer risk.

F. Pain Management and Supportive Care

• Lidocaine or Benzocaine Gels: Provide temporary pain relief.
• Antifungal Medications (e.g., Nystatin, Fluconazole): Used if secondary fungal infections occur.
• Antihistamines: May help control itching in some cases.

2. Homeopathic Treatment for Oral Lichen Planus

Homeopathy focuses on treating the root cause of OLP rather than just suppressing symptoms. Several remedies have been used with varying degrees of success.

A. Well-Known Homeopathic Remedies for OLP

1. Borax (Borate of Sodium):

   • Best for ulcerative and painful OLP.
   • Helps heal painful sores and prevents secondary infections.

2. Arsenicum Album:

   • Used for burning pain and excessive dryness in the mouth.
   • Suitable for individuals with restlessness and anxiety.

3. Mercurius Solubilis:

   • Effective for ulcers with excessive salivation and bad breath.
   • Works well when symptoms worsen at night.

4. Rhus Toxicodendron:

   • Helps in erosive OLP with burning and itching.
   • Best for cases aggravated by stress.

5. Natrum Muriaticum:

   • Used for white lace-like patches with dryness.
   • Especially beneficial for individuals with emotional stress.

6. Sulphur:

   • Suitable for chronic, long-standing cases with redness and inflammation.
   • Works well when symptoms are aggravated by heat.

B. How Homeopathy Works for OLP

• Reduces immune system hypersensitivity.
• Promotes mucosal healing and regeneration.
• Minimizes pain and burning sensations.
• Addresses underlying emotional or stress-related triggers.

C. Duration of Treatment and Effectiveness

• Mild Cases: Improvement in 3–6 months.

• Moderate Cases: May take up to a year.

• Severe Cases: Require long-term management.

• Effectiveness:

  • Homeopathy works best when taken early in the disease course.
  • Individualized treatment (based on symptoms and constitution) improves results.

3. Lifestyle and Dietary Modifications

Along with medical and homeopathic treatments, certain lifestyle changes can help manage OLP effectively.

A. Dietary Recommendations

1. Avoid Spicy, Acidic, and Hot Foods:
   • These can aggravate ulcers and increase discomfort.
2. Reduce Sugar and Processed Foods:
   • Helps prevent secondary infections and reduces inflammation.
3. Increase Antioxidant-Rich Foods:
   • Green leafy vegetables, berries, turmeric, and vitamin C help in healing.
4. Drink Plenty of Water:
   • Keeps the mucosa hydrated and prevents dryness.

B. Oral Hygiene Practices

• Use a soft-bristled toothbrush to prevent trauma.
• Avoid alcohol-based mouthwashes, as they can cause burning.
• Consider aloe vera gel or coconut oil pulling for soothing effects.

C. Stress Management

Since stress can trigger or worsen OLP, incorporating relaxation techniques can help:

• Yoga and Meditation: Lower anxiety and improve immunity.
• Breathing Exercises: Help reduce tension.

Can Oral Lichen Planus Lead to Complications?

Potential complications include:

• Malignant Transformation: A small percentage of OLP cases may develop into oral squamous cell carcinoma.

• Secondary Infections: Ulcerated lesions can become infected with bacteria or fungi.

• Nutritional Deficiencies: Painful lesions may lead to difficulty eating, resulting in inadequate nutrition.

Regular follow-ups with a healthcare provider are crucial for early detection and management of these complications.

How Can Oral Lichen Planus Be Managed at Home?

In addition to medical treatments, self-care strategies include:

• Maintaining Good Oral Hygiene: Regular brushing and flossing to prevent secondary infections.

• Avoiding Trigger Foods: Such as spicy, acidic, or rough-textured foods that can irritate lesions.

• Quitting Tobacco and Alcohol: These substances can exacerbate symptoms and increase cancer risk.

• Stress Management: Stress may worsen symptoms; techniques like meditation or yoga can be beneficial.

Consulting with a dentist or oral specialist can provide additional personalized recommendations.

Is Oral Lichen Planus Contagious?

No, OLP is not contagious. It cannot be transmitted to others through saliva, kissing, or sharing utensils. It is considered an autoimmune condition rather than an infectious disease.