Hands OnOral lichen planus management
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Background
Oral lichen planus (LP) is an immune-mediated, chronic inflammation that causes erosion of the oral mucosa and is most commonly seen in women age 40 to 50 years. The four types of LP are reticular, erosive, atrophic, and bullous, with reticular LP being the most common variety. Several factors and/or conditions can contribute to the development of LP. In addition, patients tend to experience periods of remission and recurrence. The characteristics of each type of LP and treatment options were
Characteristics
The cause of LP is unclear but research indicates that LP appears to be an immune-mediated disorder. Some cases may be refractory to immunologic intervention, with an underlying neurogenic etiology.
Factors/conditions reported to be related to mucosal LP include genetics, infection, medications, vitamin or mineral deficiencies, certain systemic diseases, and amalgam hypersensitivity (Table 1). Many common medications can be problematic for patients, including antihypertensive agents,
Pharmacologic Management
First-line therapy is topical corticosteroids, which generally reduce symptoms and minimize the effects of the disease among those with severe cases. Among the high-potency topical treatments that have proved useful are clobetasol, fluocinonide, and halobetasol, all of which are in cream or ointment form. Lesions are coated with the medication after each meal and at bedtime. Sometimes an acrylic appliance is used to hold the medication against the mucosa. Dexamethasone is effective against
Nonpharmacologic Management
The treatment of ELP may include photochemotherapy (PUVA therapy), which uses psoralen plus ultraviolet light; photodynamic therapy; and laser therapy. Dentists are unlikely to use anything other than the laser approach, and none of these approaches are well supported by the current evidence. PUVA is associated with several adverse events, including nausea, dizziness, and 24-hour photosensitivity. Laser phototherapy (LPT) has been applied three times a week for recalcitrant ELP and is
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Parsons KM: The management of oral lichen planus. Dent Econ 106:91-95, 2016
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