Urban legends series: lichen planus.
Oral Diseases (2012) Lichen planus (LP) is a common disorder affecting the oral cavity (OLP) and skin. Despite intensive research, LP/OLP etiology and treatment remain controversial. We investigated four controversial topics: (i) Is hepatitis C virus (HCV) infection associated with LP and involved in its pathogenesis? (ii) Should all patients with LP be screened for HCV? (iii) Should patients with OLP have all their amalgam restorations removed? (iv) Are there any new treatments for OLP? Results from extensive literature searches suggested that: (i) Robust evidence from three meta-analyses indicate that HCV is associated with LP and might be involved in OLP pathogenesis (ii) It would be prudent to screen patients with LP/OLP at significant risk with an ELISA for HCV antibodies using country-specific screening strategies (iii) There is no evidence that either OLP or oral lichenoid lesions patients would routinely benefit from having all their amalgam restorations replaced. Weak evidence from potentially very biased, small, non-randomized, unblinded studies suggests that a small fraction of patients may benefit from targeted amalgam replacement. (iv) There is weak evidence that, among new OLP treatments, topical pimecrolimus, aloe vera, and oral curcuminoids may be useful. The development of specific formulations for oral delivery of topical medications is a promising field.
Department of Epidemiology, University of Nebraska Medical Center, Omaha, NE, USA Department of Oral Medicine, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand Department of Oral Medicine, Centre for Oral Health Research, Newcastle University, Newcastle upon Tyne, UK Department of Dermatology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA.
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D019698:Hepatitis C, Chronic / Q000150:complications / Q000175:diagnosis; D006801:Humans; D017676:Lichen Planus, Oral / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology