What are the other Names for this Condition? (Also known as/Synonyms)

• Oral ELP
• Oral Lichen Planus, Erosive type

What is Oral Erosive Lichen Planus? (Definition/Background Information)

• Lichen planus is a common benign condition of generally unknown cause affecting the skin and mucus membranes. Erosive lichen planus (ELP) is described as a subtype of lichen planus chronically affecting the mucus membranes resulting in severe pain and ulcerative lesions. In a vast majority of cases, the involvement of the oral cavity surfaces and genitalia is noted
• Oral Erosive Lichen Planus typically involves the mucosal surfaces of the mouth such as the gums and cheeks. It an autoimmune disorder of T-lymphocytes (a type of white blood cells) with the skin manifestations being an inflammatory response of the body. The condition is more common in adult women
• The treatment for Oral Erosive Lichen Planus may involve the use of topical steroid gels and creams, mouthwashes, and systemic medications. The prognosis is dependent on a variety of factors; although in many, the condition is longstanding

Who gets Oral Erosive Lichen Planus? (Age and Sex Distribution)

• Oral Erosive Lichen Planus may be seen in middle-aged and older adults in the age group of 40-80 years. The condition is rarely observed in children
• It can affect both males and females, although women are affected more than men (a 3:1 woman to man ratio is noted)
• The condition occurs worldwide; individuals of all racial and ethnic background may be affected

What are the Risk Factors for Oral Erosive Lichen Planus? (Predisposing Factors)

In many cases, the risk factors for Oral Erosive Lichen Planus are not well-established.

• Use of certain medications causing drug reactions are reported in some cases
• An abnormal response of the skin microflora to some antifungal creams is also implicated

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Oral Erosive Lichen Planus? (Etiology)

Oral Erosive Lichen Planus, a subtype of oral lichen planus, is a severe autoimmune condition. It involves the T-cells (T lymphocytes) of the white blood cells and may be caused by damage of the skin cell layer termed the basal epithelial cell layer. However, the exact cause of development of this autoimmune disease remains unknown.

• A few cases of Oral Erosive Lichen Planus are drug-induced that gets better on ceasing usage of the offending medication. Some reports also inform that the condition may occur from viral infections or exposure to metals
• Some cases of lichen planus are known to develop through abnormal cell-mediated immunity; an association of the condition with other autoimmune diseases, such as alopecia areata, autoimmune thyroiditis, and vitiligo is noted

In general, erosive lichen planus is non-contagious and is not transmitted from one individual to another; one cannot contract the condition through close physical interaction with the affected individuals.

What are the Signs and Symptoms of Oral Erosive Lichen Planus?

The signs and symptoms of Oral Erosive Lichen Planus may include:

• Presence of raw and tender mouth ulcers with reddish discoloration
• At multiple locations in the mouth, large and irregularly eroded mucosal surfaces may be noted
• The gums, cheeks, tongue (along the outer border), or mucosal surfaces of the lips may be involved
• The lesions are chronic and very painful, often present for many weeks
• They are known to ulcerate and heal with scarring
• The condition may present difficulties in eating, chewing, swallowing, and even talking
• Brushing of teeth or other activities causing minor trauma may lead to bleeding from the mouth
• At such sites of minor trauma in the oral cavity, new ulcer sores may form, which is termed Koebner phenomenon

How is Oral Erosive Lichen Planus Diagnosed?

The following are the diagnostic methods and tests that may be used for Oral Erosive Lichen Planus:

• A thorough physical examination and a complete medical history are very crucial
• Oral cavity examination
• Culture studies
• Tissue biopsy: An oral tissue biopsy is performed and sent to a laboratory for a pathological examination, who examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. A biopsy is performed to rule out malignancies and other similar conditions

A differential diagnosis is important to exclude other conditions that present similar signs and symptoms. These may include:

• Allergic contact mucositis
• Leukoedema
• Leucoplakia
• Oropharyngeal candidiasis
• Squamous cell carcinoma of oral cavity

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Oral Erosive Lichen Planus?

The following complications of Oral Erosive Lichen Planus may be noted:

• Persistently painful lesions resulting in severe emotional and psychological stress
• Anxiety and depression
• Nutritional imbalance due to poor eating
• Weight loss
• Superimposed bacterial (from Staphylococcus aureus) and fungal (Candida albicans) are commonly noted
• Permanent scarring upon healing
• Squamous cell carcinoma of the mouth can develop from chronic and persistent ulcers
• Treatment complications and side effects

How is Oral Erosive Lichen Planus Treated?

The healthcare provider may adopt both topical agents and systemic medications in managing Oral Erosive Lichen Planus since it is a persistent and challenging condition to treat.

The following treatment measures may be considered:

• Maintaining good oral hygiene, dental care, and regular visits to a dentist office is recommended
• Use of topical steroidal oral pastes and/or calcineurin inhibitor mouthwashes
• Oral topical agents may be applied in the form of nasal inhalations and sprays
• Topical anesthetics, such as lidocaine, when the pain is severe
• Immunosuppressive therapy such as through cyclosporine mouthwash
• Administration of systemic steroids such as prednisone
• Medications such as methotrexate
• Oral antibiotics or antifungals for secondary infections, as required
• Providing reassurance and helping with feelings of stress and anxiety
• If erosive lichen planus is medication-induced, stopping the causative medicine can help resolve the condition

Follow-up care with regular screening and checkups are important since the condition can last for many months and years.

A few self-care tips and home remedies for Oral Erosive Lichen Planus may include:

• Avoiding spicy and hot foods
• Avoid foods that take an effort to bite and chew
• Use soft toothbrushes
• Drinking lots of water or fluids

How can Oral Erosive Lichen Planus be Prevented?

• Currently, there are no specific methods or guidelines to prevent Oral Erosive Lichen Planus
• A careful and periodic monitoring or follow-up of the condition is recommended

What is the Prognosis of Oral Erosive Lichen Planus? (Outcomes/Resolutions)

• The prognosis of Oral Erosive Lichen Planus depends on a variety of factors such as:
  • Age and health status of the individual; immunocompromised individuals have a much worse prognosis
  • Severity of signs and symptoms and development of complications
  • Response of the condition to treatment
  • Whether any transformation to malignancies is noted
• In many individuals, the condition is longstanding and persistent despite appropriate therapy; also, relapses are frequently noted
• The risk for squamous cell carcinoma formation is high in the following situations:
• In chronic smokers
• In individuals with a poor immune system due to various conditions

Additional and Relevant Useful Information for Oral Erosive Lichen Planus:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/dental-health/