Oral Lichen Planus

Oral Lichen Planus is a chronic, inflammatory pathology of unknown aetiology and autoimmune pathogenesis; it is more common in women between the ages of 50 and 60 years of age. Clinically, various types are recognised, being reduced to two categories, distinguishable by their white and/or red colour.
When the lesions are white, they can also appear with plaque lesions (very similar to leukoplakia) or interspersed by lacy lines (Wickham’s striae), which confer a tree-like appearance to the lesions. They are often bilaterally present on the buccal mucosa and are not particularly symptomatic.
Red lesions appear as erythematous and/or atrophic/erosive or vesicular-bullous, and they are very painful. Typically, white and red lesions co-exist throughout a patient’s medical history, occurring one after the other, following periods of remission and flare-up of the pathology. The passage from a white lesion to a red lesion is also correlated with a worsening of the clinical picture and the symptomatological pathway (pain, burning, dysgeusia, changes in phonation, chewing and deglutition).
A biopsy is always necessary to diagnose oral lichen planus, followed by a histo-cytopathological examination. This pathology can present dysplasia and develop into a malignant form in 0.3% and 0.5% of cases.
The non-symptomatic types should only be monitored over time with periodic follow-up without any pharmacological treatment; symptomatic types, however, make necessary the use of the topical treatment of anti-inflammatory corticosteroids.
After a diagnosis of oral lichen planus has been made, it is necessary to exclude the involvement of other muco-cutaneous sites. Thus, the patient can be referred for a dermatological (skin lesions in the form of red-mauve papule, situated on painful and/or itchy joints) and gynaecological (gingival-vulvo-vaginal syndrome) assessments, also in the absence of specific symptoms. More rarely, the ocular and oesophageal mucosa can be affected.