OLP, nodular lichen
Oral lichen planus (OLP), also called nodular lichen, is an autoimmune disease that affects the mucous membranes. Whitish nodules or reticular changes form on the oral mucosa. Certain forms may cause discomfort in the sense of pain or burning.
As lichen ruber planus, nodular lichen can also cover the skin – often on the wrists, ankles or lower leg. The symptoms can usually be treated well with cortisone. In the oral mucosa, the disease is often chronic.
The term “lichen” comes from botany and refers to plants known as lichens. “Planus” comes from Latin and means surface. Oral lichen planus is a chronic inflammatory disease of the oral mucosa. In addition to the oral mucosa, the skin or genital mucosa may also be affected. A striking feature of oral lichen planus is the reticular white structure seen on the mucous membranes. The white lines are also called Wickham stripes after their discoverer. What exactly causes this disease is not yet fully understood. However, an autoimmune cause is thought to be involved. The symptoms usually occur in episodes and disappear after a few months. In chronic lichen planus, there is concern that the nodules may develop into cancer. Therefore, close monitoring is important. All forms of oral lichen planus are not contagious.
Oral lichen planus is relatively common: Around two percent of all people in Switzerland suffer from this disease. Middle-aged people are more frequently affected: The disease occurs mainly between the ages of 30 and 60. In some patients only the oral mucosa is affected, in others there are also spots on the skin. Men and women are affected equally, and according to some studies, women are affected slightly more often. Lichen planus on the oral mucosa is much more common than that on the skin. However, lichen ruber planus is also one of the most common skin diseases.
The cause of oral lichen planus has not yet been fully elucidated. However, it is known that T lymphocytes – cells of the immune system – play a role. They are located under the epidermis and attack the cells of the epidermis from there. However, a genetic predisposition also appears to be a risk factor: In some families, several family members exhibit the disease symptoms.
Oral lichen planus can occur in various locations on the body. The oral mucosa shows whitish changes, which may be patchy or reticular. Certain forms of OLP often do not cause symptoms. Erosive or ulcerative forms that have an open, affected surface may cause pain or burning of the oral mucosa. In particular, discomfort may occur when eating sour or spicy foods and drinks.
In oral lichen planus, white and red forms are distinguished. In the white form, whitish spots or streaks (called Wickham’s streaks) form on the oral mucosa. Very often the buccal mucosa, the lateral margin of the tongue are affected, less frequently the gum line. The white forms usually do not cause any symptoms and do not need to be treated. However, a regular check-up with the dentist is necessary at least every 6 to 12 months. Red forms such as erosive oral lichen planus are often accompanied by discomfort. In this case, drug treatment is then also necessary.
Those affected by lichen ruber planus of the skin usually also have oral lichen planus of the oral mucosa at the same time. Conversely, only one in five affected persons of oral lichen planus also develops nodular lichen on the skin.
First, the entire oral mucosa is examined and often documented photographically. With a swab of the affected areas, we can rule out a fungal infection with Candida albicans, for example. If a fungal infection is present, this is first treated with medication. Then, a tissue sample (biopsy) can be taken to diagnose oral lichen planus.
Early detection of oral lichen planus is often done by the dentist/dental hygienist. The disease cannot be prevented. It is important to maintain good oral hygiene and avoid any irritation or injury to the oral mucosa. Injuries to the mucosa can trigger a new relapse if OLP is already present.
If you have a history of oral lichen planus, be aware of the following:
A regular check-up visit to the dentist helps to detect and treat a recurrence of oral lichen planus in time.
Oral lichen planus is a chronic disease and a cure is often not possible. The aim of therapy is to alleviate the symptoms.
Asymptomatic forms of oral lichen planus usually do not require treatment. If symptoms occur, therapy with local corticosteroids is started. In addition, there are mouth rinses and ointments/gels for the oral mucous membranes. Since about one third of patients develop a fungal infection during treatment with cortisone, we add an antifungal agent at the same time as a prophylactic measure. In cases where local treatment does not bring the desired success, systemic corticosteroids in the form of tablets can also be used.
While lichen ruber planus of the skin can usually be treated well, therapy for oral lichen planus in the mouth is often protracted. On average, sufferers only get their symptoms under control after five years. Due to the chronic course with recurrent inflamed papules, there is a risk that these may also become malignant. Open areas can easily form precancerous lesions. This occurs in 0.4 to 5.6 percent of all sufferers. Therefore, regular visits to the doctor for control are very important.
As a patient, you cannot register directly for a consultation. Please get a referral from your primary care physician, specialist. For questions please use our contact form.
University Hospital Zurich
Department of Cranio-Maxillo-Facial and Oral Surgery
Rämistrasse 100
8091 Zurich