Oral lichen planus
Reticular striae, erythema and ulceration vary by site and symptoms. Confirm the diagnosis when uncertain and monitor symptomatic or changing lesions.
Understand
Oral lichen planus can be reticular, erythematous or erosive, commonly bilateral but not always. Drug- or contact-related lichenoid reactions and dysplasia can mimic it.
Assess
Record sites, symptoms and provoking factors; consider biopsy when diagnosis is uncertain, unilateral, changing or atypical. Assess for superimposed candidosis in symptomatic patients.
Apply
Manage triggers and symptoms, usually with topical therapy under appropriate guidance, and review. A focal indurated area is not safely explained by a background of lichen planus.
Key distinctions
Reticular OLP may be asymptomatic; erosive disease can cause substantial pain. A lichenoid drug or contact reaction may be asymmetric and linked to a trigger, but presentation overlaps. A biopsy may help when the pattern is atypical or a focal area changes. Long-term care includes symptom control and reassessment of lesions that cease to fit the established diagnosis.
Think through a case
A patient with long-standing bilateral reticular OLP develops a new focal ulcerated indurated area. Do not assume it is simply a flare.
The distinction to remember
Do not prescribe systemic steroid therapy before considering infection and the need to investigate an atypical focus.
Test your recall
What could make an assumed OLP diagnosis unsafe?
Show answer
A focal indurated or progressively changing area.