Oral Lichen Planus

What is oral lichen planus?

Oral lichen planus is a long-term (chronic) disease that affects the inside your mouth. Technically, lichen planus can develop on your skin or anywhere you have mucosa. (Mucosa is the thin layer of tissue that lines certain body parts, like your nose, mouth, stomach and lungs.) But when lichen planus appears in your mouth, it’s called oral lichen planus.

You can get oral lichen planus on your:

• Inner cheeks.
• Gums.
• Tongue.

Oral lichen planus vs leukoplakia: What’s the difference?

Leukoplakia and oral lichen planus are both disorders that affect the mucosa inside your mouth. Both conditions can cause white discoloration on your inner cheeks, gums and sometimes tongue. But these two disorders are very different:

• Oral lichen planus: Oral lichen planus results in white, lacy, thread-like lesions or bright red gum tissue. The cause isn’t fully understood, but there may be a connection to autoimmune diseases.
• Leukoplakia: Leukoplakiaresults in thick, white patches. Other symptoms include mouth sores and a white tongue. This condition could be the result of heavy smoking, chewing tobacco or heavy alcohol use. Unlike oral lichen planus, leukoplakia is more likely to turn into oral cancer.

Who does oral lichen planus affect?

Anyone can develop oral lichen planus. Women and people assigned female at birth are twice as likely as men and people assigned male at birth to develop the condition. Most cases of oral lichen planus occur in adults over the age of 50.

How common is oral lichen planus?

The skin and oral types of lichen planus together affect an estimated 2% of the population.

What does lichen planus look like in the mouth?

Oral lichen planus usually appears one of two ways: white, web-like lesions or bright red gum tissue. Healthcare providers categorize these symptoms into types: reticular and erosive oral lichen planus.

• Reticular oral lichen planus: For most people, oral lichen planus appears as white patches or thread-like lesions on the inside of your cheeks. These areas are typically raised slightly. Reticular lichen planus usually isn’t painful.
• Erosive oral lichen planus: In some cases, people with oral lichen planus have bright red gum tissue. In severe cases, ulcers can develop on your gums, tongue or on the floor of your mouth. Eating and drinking hot, spicy or acidic foods or drinks can be painful for people with erosive oral lichen planus.

Skin lesions are common among people with oral lichen planus. Almost half of people with oral lichen planus also have skin lichen planus, which causes itching.

What causes oral lichen planus?

Experts don’t know exactly why oral lichen planus occurs. Research suggests that your genetic makeup and immune system both play a role.

Some people develop oral lichen planus after taking certain medications, such as:

• Beta-blockers.
• Nonsteroidal anti-inflammatory drugs (NSAIDs).

Certain diseases may also result in oral lichen planus, such as:

• Hepatitis B.
• Primary biliary cirrhosis.

Is oral lichen planus contagious?

No, oral lichen planus doesn't spread from person to person.

How is oral lichen planus diagnosed?

Your healthcare provider diagnoses oral lichen planus by examining your mouth. In many cases, providers take a tissue biopsy to confirm the diagnosis and rule out other diseases.

How do you get rid of lichen planus in your mouth?

Mild oral lichen planus may not need any treatment. Instead, your healthcare provider will monitor your condition. If symptoms worsen, your provider will likely recommend specific ways to manage your flare-up.

Milder forms of the disease usually go away on their own over time, especially if you discontinue medications that trigger the condition.

For more severe cases, your healthcare provider will likely recommend medication. Common oral lichen planus treatments include:

• Corticosteroids.
• Lidocaine.
• Tacrolimus.
• Dapsone.
• Cyclosporine.

Can oral lichen planus cause complications?

Oral lichen planus is a chronic, or long-term, condition. Occasional flare-ups are common.

More severe forms of oral lichen planus, called erosive lichen planus, can make it painful to eat, drink or brush your teeth.

It hurts to brush my teeth during an oral lichen planus flare up. What can I do?

When oral lichen planus flares up, it might be uncomfortable to brush and floss your teeth. However, to keep your teeth and gums healthy, good oral hygiene is essential. Be sure to brush your teeth two to three times a day and floss daily.

To minimize discomfort, use a soft-bristled toothbrush and a fluoride toothpaste without a lot of flavoring and additional ingredients. Ask your dentist for recommendations.

Is there a link between oral lichen planus and cancer?

Some research indicates a greater likelihood of developing oral cancer if you have erosive oral lichen planus. In general, about 1% to 3% of people with oral lichen planus get oral cancer at some point.

These statistics are controversial, however. Some experts believe that misdiagnoses were responsible for a large portion of those cases. Regardless, people with erosive lichen planus should attend routine follow-ups to monitor their condition.

Can I prevent oral lichen planus?

There's no way to prevent oral lichen planus. You can lower your risk for oral lichen planus and other oral conditions by eating a variety of fruits and vegetables, not drinking large amounts of alcohol and quitting smoking.

Does oral lichen planus go away?

For many people, oral lichen planus eventually disappears. However, the condition can take years to resolve. Flare-ups are common, even with treatment.

Is oral lichen planus serious?

No. Even though oral lichen planus can result in some uncomfortable symptoms, the condition isn’t dangerous, and it usually isn’t a cause for concern.

When should I see my healthcare provider?

If you have white, thread-like lesions or red patches in your mouth, schedule a visit with your healthcare provider right away. They can give you a proper diagnosis and find ways to manage your symptoms.

A note from Cleveland Clinic

Oral lichen planus isn’t dangerous, but it can be irritating and inconvenient. Because oral lichen planus can sometimes mimic other, more concerning conditions, it’s important to get a proper diagnosis. If you have frequent flare-ups, talk to your primary care physician or dentist about how to manage your symptoms.