Lichen Planus-DoctorSpiller.com

Lichen Planus, a dermatological condition in the mouth

LikenPlanus

Copyright 2006 Martin S. Spiller, D.M.D. courtesy of Dr. Ed Cataldo

Lichen Planus

Lichen Planus is a benign dermatological condition which seems to be associated with a reaction to certain drugs.  It’s most characteristic appearance is as a series of filamentous lines (Striae of Wickham) occurring on various oral tissues as in the image above.  It is generally easy for most dentists to diagnose when it occurs on the cheeks as seen here, but it can occur on attached tissues such as the hard palate or even the gingiva as well.  Lesions on unattached tissues such as the buccal and sublingual mucosa are likely to be painless, but the lesions on the hard tissues like the palate are often quite painful. The blue-gray spot to the lower right is an amalgam tattoo.

LichenPlanus2

Copyright 2006 Martin S. Spiller, D.M.D.

The  image above is presented in its present size to show a much more subtle presentation.  The lichen planus is located toward the back of the undersurface of the tongue, looking a bit like subtle lettering.  It still shows the characteristic filamentous appearance, but may be easily overlooked or misdiagnosed when its appearance is not typical.

The ultimate cure for the condition is to identify the noxious drug or substance that causes it and eliminate it.  Baring that, any mild symptoms associated with it can be controlled using steroid mouth rinses.

Lichen Planus is a dermatological condition that is not limited in extent to the oral cavity.  It is often found in association with red sores in the anticubital space (on the upper surface of the arm opposite the elbow.)

Treatment of the more painful lesions is generally accomplished with topical steroid creams, ointments, gels or rinses.

  • Fluocinonide 0.05% gel or cream
    • Disp: 30 gm tube
    • Sig: apply thin coat to ulcer four times a day after meals and at bedtime. do not eat or drink for 30 minutes after applying. Do Not Use For More Than 2 Weeks.

Shortens duration and severity of lesions. Risk of mucosal atrophy and systemic absorption with prolonged use.

  • Clobetasol propionate 0.05% ointment
    • Disp: 30 gm tube
    • Sig: apply thin coat to ulcer four times a day after meals and at bedtime. do not eat or drink for 30 minutes after applying. Do Not Use For More Than 2 Weeks.

Shortens duration and severity of lesions. Risk of mucosal atrophy and systemic absorption with prolonged use.

  • Dexamethazone elixir 0.5 mg.5 ml
    • Disp: 100 ml
    • Sig: Rinse with one teaspoonful for three minutes four times daily after meals and expectorate. DO NOT SWALLOW. do not use for more than two weeks.

Shortens duration and severity of lesions. Risk of mucosal atrophy and systemic absorption with prolonged use. Risk of secondary infection with Candida albicans.

If the lesions are on the gingiva or palate, treatment using Lidex (fluocinonide) Gel is extremely effective if it is applied using a custom tray.