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Lichen Planus

What is Lichen Planus?

Lichen planus is a chronic disease, which can affect the skin and mouth and, in some cases, the genitalia. It affects 1-2% of men and women in the UK and is more common in people over 40 years old. It is not a cancer or an infectious disease that can be passed on and it does not run in families.

What are the signs and symptoms?

Lichen planus appears in a wide variety of ways and can cause pain, burning and/or soreness in the mouth. It can often go unnoticed and may only be recognised by a dentist or hygienist during a routine examination. White, net-like lines or white patches are usually seen on the inside of both cheeks and can also appear on the tongue and gums. They do not usually cause any discomfort.

In some cases, red patches, ulcers or blisters appear, which can be very painful. The gums can also become thin, red and shiny in appearance and painful to brush. About one third of people also get a purple, itchy rash with raised dots on the skin especially on the wrists and shins. Very rarely, changes are also found on the genitalia, hair and nails.

What are the causes of Lichen Planus?

The cause of Lichen Planus is not known but is probably related to the immune system where cells that normally fight off germs attack normal parts of the body. Certain drugs used in the treatment of high blood pressure, arthritis and diabetes may cause lichen planus-like lesions. Emotional stress and spicy food or citrus fruits can often cause symptoms to worsen.

How can it be treated?

As long as there is no pain, treatment is not usually necessary. In all cases it is important to keep your mouth clean, as it stops the lichen planus getting infected.

There are many different treatments available for treating the condition. Your dentist will be able to recommend an appropriate one for you. Mouthwashes containing Chlorhexidine are used when no pain is evident. There are also special sprays and creams available to help relieve pain.

There are a variety of topical steroid preparations available. These drugs are not absorbed into the body as they only work on the area they are applied to, and therefore cause no side effects.

Adcortyl in Orabase is one of these creams. Dry the area with a cotton wool bud before rubbing in a pea-sized amount of the cream using a wet cotton wool bud. It is best to use the cream at night so that it does not rub off during eating or talking.

Corlan pellets can be placed on the affected area and sucked slowly, but they do have a bitter taste.

Becotide spray is occasionally used for those areas of the mouth where it is difficult to reach with other remedies. Use 2-3 puffs of the pump on the area that is sore. Do NOT breathe in at the time of puffing. Hold your breath, as you do not want the spray to go down into your lungs. You can use it up to four times a day.

Bioplex is a non steroidal powder, which you make up as a mouthwash in a quarter of a cup of warm water. Use it up to four times a day.

It may be an idea to try to identify factors that make the problem worse e.g. stress, spicy foods especially chillies, citrus fruit and strongly flavoured toothpastes.

In more severe cases the hospital doctor will prescribe some stronger medication.

What happens now?

Oral lichen planus may last from several weeks to several years but will slowly disappear over time. Most skin sores heal by themselves within 18 months and are unlikely to recur. It is always advisable to have regular check-ups in order to monitor the disease and any intermittent soreness. Avoid tobacco products and paan chewing as these increase your chance of oral cancer.

If the lichen planus changes in appearance or causes more pain see your dentist or specialist.

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