Oral lichen planus and oral lichenoid lesions: diagnostic and therapeutic considerations

published online 03 February 2007.

Several therapeutic agents have been investigated for the treatment of oral lichen planus (OLP). Among these are corticosteroids, retinoids, cyclosporine, and phototherapy, in addition to other treatment modalities. A systematic review of clinical trials showed that particularly topical corticosteroids are often effective in the management of symptomatic OLP lichen planus. Systemic corticosteroids should be only considered for severe widespread OLP and for lichen planus involving other mucocutaneous sites. Because of the ongoing controversy in the literature about the possible premalignant character of OLP, periodic follow-up is recommended.

There is a spectrum of oral lichen planus–like (“lichenoid”) lesions that may confuse the differential diagnosis. These include lichenoid contact lesions, lichenoid drug reactions and lichenoid lesions of graft-versus-host disease. In regard to the approach to oral lichenoid contact lesions the value of patch testing remains controversial. Confirmation of the diagnosis of an oral lichenoid drug reaction may be difficult, since empiric withdrawal of the suspected drug and/or its substitution by an alternative agent may be complicated. Oral lichenoid lesions of graft-versus-host disease (OLL-GVHD) are recognized to have an association with malignancy. Local therapy for these lesions rests in topical agents, predominantly corticosteroids.

a Director of Salivary Dysfunction Clinic, Baylor College of Dentistry, Houston, TX.

b Head of Department, University of Sydney, Westymend Centre for Oral Health, Westmend Hospital, Sydney, Australia.

c Chairman, Department of Oral Medicine, Carolinas Medical Center, Charlotte, NC.

d Department of Oral Medicine, University of Glasgow, Glasgow, Scotland.

e Oral Medicine Program Director, Carolinas Medical Center, Charlotte, NC.

f Professor, NOVA Southeastern University, College of Dental Medicine.

g County Hospital, Halmstad, Sweden.

h Consultant, Department of Dermatology, Mayo Clinic, Rochester; Assistant Professor, Mayo College of Medicine, Mayo Clinic, Rochester, MN.

i Consultant in Oral Pathology, School of Dentistry, San Francisco, CA.

j Professor, Oral Heal and Diagnostic Sciences and Division Head, University of Connecticut Health Center, Farmington, CT.

k Professor and Head of Oral Medicine, College of Dentistry, Chicago Cancer Center, Chicago, IL.

l Professor and Chairman, University of Copenhagen, School of Dentistry, Copenhagen, Denmark.

m Professor, Sahlgrenska Academy, Goteborg, Sweden.

n Professor of Clinical Oral Medicine, University of California, San Francisco, CA.

o Senior Lecturer in Oral Medicine, Griffith University, Gold Coast, Queensland, Australia.

p University of California, San Francisco, CA.

q Professor, Oral Medicine Department, Chulalongkorn University, Bangkok, Thailand.

r Chair, Oral Medicine, University of Sheffield, School of Clinical Dentistry, Sheffield, UK.

s Professor of Oral Medicine and Experimental Oral Pathology, University of London, Guy’s, King’s and St. Thomas’ Dental Institute, London, UK.

t Head, Professor of Oral Pathology, VU University Medical Centre (Vumc)/Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, Netherlands.

Reprint requests: Isaäc van der Waal, DDS, PhD, Department of Oral and Maxillofacial Surgery/Oral Pathology, VU university medical centre (VUmc)/Academic Centre for Dentistry Amsterdam (ACTA), PO Box 7057, 1007 MB Amsterdam, The Netherlands

PII: S1079-2104(06)00860-2

doi:10.1016/j.tripleo.2006.11.001

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