Q: I’m so glad there is someone to “talk” to about my sister. She is 56 years old, diagnosed with lupus four months ago. She hurts so bad with fibromyalgia but her biggest need is help from the lesions in her mouth – lichen planus. She’s under a doctor’s care but nothing they prescribe seems to work. She’s tried rinses, mouth washes, medicated gum and pain meds. Please, is there something you can suggest? I’d be grateful for any information you can share.
A:Lichen planus is an inflammatory disorder that occurs when a person’s immune system mistakenly attacks the cells of the skin and mucous membranes. It commonly forms purple bumps on the wrists, ankles, or external genitalia, hair loss and discoloration of the scalp, painful vaginal lesions, and more. When the mouth is affected, the ulcers may take on the appearance of lace, be purple and pimple-like . The lesions may gradually increase in size, and become painful. They are more commonly seen on the sides of the tongue, gums, and insides of the cheeks. The occurrence of lichen planus has, on rare occasions, been associated with the hepatitis B and flu vaccines and there is a known correlation between lichen planus and liver disease. Anyone can develop the disorder but it most frequently affects middle-aged adults. It is not contagious, she cannot pass it on to anyone else, nor did she acquire it from anyone. Emotional stress has long been considered to be a contributing factor for an outbreak or exacerbation to occur.
Diagnosis may be accomplished through allergy testing in which the specialist will attempt to determine what the individual is exposed to that may caused an adverse reaction. Or, a biopsy may also be done to determine if that allergy is an underlying cause for the disorder.
As a first line of treatment, maintenance with good oral hygiene (brushing twice daily, followed by flossing, regular dental checkups and care), the elimination of mechanical irritations from dental restorations, avoidance of habits that cause trauma such as chewing on the lips or mucosa, and cessation of smoking are recommended. It may also help if she were to minimize her consumption of acidic, salty, spicy, or hot foods. She might speak with her physician regarding corticosteroids to reduce inflammation, synthetic versions of vitamin A taken by mouth or applied topically, non-steroidal topical remedies, antihistamines to reduce pain and itching, phototherapy, and still more. Corticosteroids should be taken short-term and only as directed since side effects may include osteoporosis, elevated blood glucose levels, and hypertension. Those who don’t respond to steroids might move to second-line treatments with immunosuppresant drugs such as topical pimecrolimus and tacrolimus. Synthetic vitamin A can result in skin dryness, and peeling. Synthetic A is not recommended for pregnant women or those who may become pregnant because oral retinoids may harm unborn babies. Light therapy can result in sunburn, cataracts and a rare but potential long-term risk for the development of skin cancer.
No true cure exists for oral lichen planus. Treatment is geared around antihistamines, anti-inflammatory and immunosuppressant agents, anti-fungal agents, dental hygiene products and stress reduction that might be in the form of yoga, tai chi, or listening to good music, along with eating well, and avoiding foods such as spices that can cause mouth irritation.
I wish I were able to offer more but coupled with her fibromyalgia and lupus, your sister really has her hands full. You did not indicate which drugs she is on for her other medical conditions. She might wish to check with her prescribing physician to determine if one of the drugs he or she has her on may be the trigger for her lichen planus to exacerbate. She should make an appointment with a top notch dermatologist at a local teaching hospital or dental school familiar with oral lichen planus who may have further suggestions for control. Good luck.