EC Dental Science

Oral lichen planus (OLP) is a chronic inflammatory condition affecting the mucous membranes of the mouth, often presenting as white, lace-like patches, erosions, or ulcers. Its etiology is not fully understood but is believed to involve autoimmune mechanisms, leading to T-cell-mediated damage to the basal cells of the oral epithelium. OLP affects approximately 1 - 2% of the population and can significantly impair patients' quality of life, especially due to symptoms like persistent pain, burning sensation, and the risk of malignant transformation.

Despite the availability of various treatment options, managing OLP remains a challenge for clinicians. The chronic and recurrent nature of the disease, along with the variable patient response to therapies, complicates its management. Corticosteroids are commonly used as a first-line treatment; however, patients often encounter limitations, including treatment resistance, side effects, and recurrence of symptoms after therapy cessation.

This article explores the challenges and difficulties encountered in the management of OLP, illustrated through a clinical case that highlights the complexities of diagnosis and long-term treatment, as well as the impact of the disease on patient quality of life.

Keywords: Oral Lichen Planus (OLP); Corticosteroids; Autoimmune Mechanisms

1. Lysitsa S., et al. “Lichen plan buccal: histoire naturelle et transformation maligne”. Médecine Buccale Chirurgie Buccale1 (2007): 19-29.
2. Gururaj N., et al. “Diagnosis and management of oral lichen planus-Review”. Journal of Oral and Maxillofacial Pathology3 (2021): 383-393.
3. Li C., et al. “Global prevalence and incidence estimates of oral lichen planus: a systematic review and meta-analysis”. JAMA Dermatology2 (2020): 172-181.
4. González-Moles MÁ., et al. “Worldwide prevalence of oral lichen planus: A systematic review and meta-analysis”. Oral Diseases4 (2021): 813-828.
5. Akyüz Mehmet., et al. "Corticosteroids and immunosuppressants on oral lichen planus’ treatment”. European Journal of Therapeutics 3 (2024).
6. García-García V., et al. “New perspectives on the dynamic behaviour of oral lichen planus”. European Journal of Dermatology 2 (2012): 172-177.
7. Didona D., et al. “Therapeutic strategies for oral lichen planus: State of the art and new insights”. Frontiers in Medicine (Lausanne) 9 (2022): 997190.
8. Mehrbani SP., et al. “Role of interleukin-4 in pathogenesis of oral lichen planus: A systematic review”. Medicina Oral, Patologia Oral, Cirugia Bucal 3 (2020): e410-e415.
9. M Ouled Bouallala., et al. “Le lichen plan oral: revue de littérature”.
10. De Porras-Carrique T., et al. “Depression, anxiety, and stress in oral lichen planus: a systematic review and meta-analysis”. Clinical Oral Investigations 2 (2022): 1391-1408.
11. Xiaolin Zhang., et al. “Characteristics and pathogenesis of Koebner phenomenon, experimental dermatology”. Experimental Dermatology 4 (2023): 310-323.
12. S Adnan, et al. “Hepatitis C virus infection and oral lichen planus: a controversial association”. Advances in Oral and Maxillofacial Surgery 6 (2022): 100271.
13. Edwards Paul C and Robert Kelsch. "Oral lichen planus: clinical presentation and management”. Journal of Canadian Dental Association8 (2002):494-499.
14. Rai B., et al. “Possible action mechanism for curcumin in pre-cancerous lesions based on serum and salivary markers of oxidative stress”. Journal of Oral Science 2 (2010): 251-256.
15. Bouzoubaa SM and Ben Yahya I. “Le lichen plan buccal: mise au point Le courier du dentist” (2013).
16. Pan YX., et al. “[Gene polymorphism in oral lichen planus]”. Hua Xi Kou Qiang Yi Xue Za Zhi6 (2020): 681-686.
17. Rotaru Doina., et al. "Treatment trends in oral lichen planus and oral lichenoid lesions”. Experimental and Therapeutic Medicine6 (2020): 198.
18. Stone SJ., et al. “Cost-effectiveness of personalized plaque control for managing the gingival manifestations of oral lichen planus: a randomized controlled study”. Journal of Clinical Periodontology9 (2013): 859-867.
19. Sulewska Magdalena., et al. "A clinical evaluation of the efficacy of photodynamic therapy in the treatment of erosive oral lichen planus: A case series”. Photodiagnosis and Photodynamic Therapy 18 (2017): 12-19.