Stepwise approach in the management of oral lichen planus

Abstract

Lichen planus is a chronic inflammatory disease in the skin, hair, nails, and mucous membranes. Like in other sites, oral lichen planus (OLP) includes asymptomatic and flare-up or symptomatic periods. The symptomatic period is characterized by erosive, ulcerative, or painful symptoms. In addition, some lesions may have potentially malignant transformation. Despite many molecular-based studies, the OLP etiology is still unclear. Hence, there is no gold-standard therapy for OLP so far. The management of symptomatic lesions is based on each individual’s clinical features, and treatment outcomes are often unpredictable. That explains why most dentists are not confident in dealing with this disease. Nevertheless, there is a consensus among the majority of authors that the pathogenesis of OLP, as an immune-mediated disease, is related to T-lymphocyte immunological dysfunction. Medical treatment, using immunosuppressant therapies or immunomodulators, aims (1) to alleviate painful symptoms, (2) to heal the ulcerative and atrophic lesions, (3) to reduce the risk of malignant transformation, and (4) to prolong the symptom‑free intervals. This review article aims to synthesize current literature evidence and integrate the authors’ experience in suggesting a stepwise approach to manage OLP patients.