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. The disease is often chronic in the oral mucosa.
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 mucous membranes can also be affected. A striking feature of oral lichen planus is the net-like, white structure that can be 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 assumed. The symptoms usually occur in episodes and disappear after a few months. In the case of chronic lichen planus, there is a risk that the nodules will develop into cancer. Close monitoring is therefore 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 mainly occurs 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 equally affected, and according to some studies, women are slightly more frequently affected. Lichen planus on the oral mucosa occurs much more frequently than 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 parts of the body. The oral mucosa shows whitish changes, which may be blotchy or reticular. Certain forms of OLP often cause no symptoms. Erosive or ulcerative forms, which have an open, damaged surface, can lead to pain or burning of the oral mucosa. Discomfort can occur in particular when eating acidic or spicy foods and drinks.
A distinction is made between white and red forms of oral lichen planus. In the white form, whitish spots or stripes (so-called Wickham’s stripes) form on the oral mucosa. The buccal mucosa and the lateral edge of the tongue are very often affected, less frequently the gum line. The white forms usually cause no symptoms and do not need to be treated. However, a regular check-up at the dentist is necessary at least every 6 to 12 months. Red forms such as erosive oral lichen planus are often accompanied by symptoms. In this case, treatment with medication is also necessary.
In most cases, people affected by lichen ruber planus of the skin also have oral lichen planus of the oral mucosa. Conversely, only every fifth person affected by oral lichen planus also develops nodular lichen on the skin.
First, the entire oral mucosa is examined and often also documented photographically. By taking 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 will be treated with medication first. A tissue sample (biopsy) can then be taken to diagnose oral lichen planus.
Early detection of oral lichen planus is often carried out by the dentist or 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 mucous membrane can trigger a new flare-up if OLP is already present.
If you have ever had oral lichen planus, you should pay attention to the following:
Regular check-ups at the dentist help to detect and treat a recurrence of oral lichen planus in good 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 generally do not require treatment. If symptoms occur, treatment with local corticosteroids is started. There are also mouthwashes and ointments/gels for the oral mucosa. As around a third of patients develop a fungal infection during treatment with cortisone, we also administer an antifungal agent 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 lengthy. On average, sufferers only get the symptoms under control after five years. Due to the chronic course with recurring inflamed papules, there is a risk that these can also become malignant. Open areas can easily form precancerous lesions. This occurs in 0.4 to 5.6 percent of all patients. Regular visits to the doctor for check-ups are therefore very important.
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University Hospital Zurich
Department of Cranio-Maxillo-Facial and Oral Surgery
Raemistrasse 100
8091 Zurich