Oral lichen planus and oral lichenoid lesions: diagnostic and therapeutic considerations.
Several therapeutic agents have been investigated for the treatment of oral lichen planus (OLP). Among these are corticosteroids, retinoids, cyclosporine, and phototherapy, in addition to other treatment modalities. A systematic review of clinical trials showed that particularly topical corticosteroids are often effective in the management of symptomatic OLP lichen planus. Systemic corticosteroids should be only considered for severe widespread OLP and for lichen planus involving other mucocutaneous sites. Because of the ongoing controversy in the literature about the possible premalignant character of OLP, periodic follow-up is recommended. There is a spectrum of oral lichen planus-like ("lichenoid") lesions that may confuse the differential diagnosis. These include lichenoid contact lesions, lichenoid drug reactions and lichenoid lesions of graft-versus-host disease. In regard to the approach to oral lichenoid contact lesions the value of patch testing remains controversial. Confirmation of the diagnosis of an oral lichenoid drug reaction may be difficult, since empiric withdrawal of the suspected drug and/or its substitution by an alternative agent may be complicated. Oral lichenoid lesions of graft-versus-host disease (OLL-GVHD) are recognized to have an association with malignancy. Local therapy for these lesions rests in topical agents, predominantly corticosteroids.
Al-Hashimi
Ibtisam
I
Salivary Dysfunction Clinic, Baylor College of Dentistry, Houston, TX, USA.
Schifter
Mark
M
Lockhart
Peter B
PB
Wray
David
D
Brennan
Michael
M
Migliorati
Cesar A
CA
Axéll
Tony
T
Bruce
Alison J
AJ
Carpenter
William
W
Eisenberg
Ellen
E
Epstein
Joel B
JB
Holmstrup
Palle
P
Jontell
Mats
M
Lozada-Nur
Francina
F
Nair
Raj
R
Silverman
Bud
B
Thongprasom
Kobkan
K
Thornhill
Martin
M
Warnakulasuriya
Saman
S
van der Waal
Isaäc
I
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D003937:Diagnosis, Differential; D006086:Graft vs Host Disease / Q000150:complications / Q000628:therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D017676:Lichen Planus, Oral / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D017512:Lichenoid Eruptions / Q000175:diagnosis / Q000628:therapy; D012176:Retinoids / Q000627:therapeutic use
D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D012176:Retinoids