Q: Do you have any information or remedies regarding lichen planus? I have endured this to my gums for many years. I have ruled out things that aggravate it such as mint tooth paste, mint-flavored dental floss, juices that contain a lot of acid, etc. I see my dentist and periodontist regularly. The periodontist prescribed Lidex gel to apply when it flares up but I would like to see it go away forever. Thanks.
A: Lichen planus is an inflammatory condition that affects mucous membranes and skin. The mouth, vagina and other areas covered by a mucous membrane will be covered with painful, white patches that will take on a lace-like appearance. When skin is affected, it is often purple in color and quite itchy. The condition occurs when the immune system inadvertently attacks cells. When the mouth is involved, symptoms will include painful white patches on the gums, lips, tongue, and inside the cheeks. Anyone of any age can develop lichen planus but it is most commonly found in those of middle age. It is not contagious, nor can an individual pass it on. There is no cure but the condition can be treated, with the objective being to reduce symptoms when they present.
Known risk factors for developing lichen planus include an immune system malfunction, having a hepatitis B vaccine, hepatitis C infection, receiving a flu vaccine, being on non-steroidal anti-inflammatory drugs such as ibuprofen, and specific medications taken for arthritis, heart disease, or high blood pressure. Emotional stress has been considered to be a contributing factor for lichen planus, especially for the phases when a bout is particularly severe.
Diagnosis is commonly made through visual examination by a specialist in oral pathology or a dermatologist; however a physician may choose to test for hepatitis C, perform allergy testing to determine what specific substances an individual comes into contact with that may be triggering an attack, or through biopsy.
And now the disturbing news. Many cases of skin lichen planus will go away in about two years, even though about one in every five individuals will have a second outbreak. And some individuals may have the skin form come and go for years; however, when it occurs in the mouth, this chronic condition often takes longer than the skin form and it can be more difficult to treat. There is no known cure for oral lichen planus, however, steroids and immunosuppressant agents are the mainstay of medical treatment. Treatment is usually local, not systemic. In some cases, concomitant topical anesthetics, analgesics and anti-fungal agents are also indicated. Gentle oral cleaning may reduce any discomfort; stress reduction techniques – perhaps with the assistance of a therapist, may help; as will allergy medication if the potential trigger can be identified.
On the home front, eliminate foods that trigger or worsen your symptoms. Lower or eliminate your consumption of caffeine, alcohol and tobacco products. Practice good oral hygiene and avoid alcohol-containing mouthwashes. Eat a nutritious diet that includes fresh fruits and vegetables. And, while easier said than done, sidestep stressful situations whenever possible.
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