Oral lichen planus is a chronic inflammatory condition affecting the mucous membranes inside the mouth. It arises when the immune system mistakenly attacks cells of the oral mucosa, leading to lesions. These can appear as white, lacy patches, red and swollen tissues, or open sores. While the condition is not contagious, it can cause discomfort, including burning sensations and pain. There is no cure for oral lichen planus, but treatments focus on managing symptoms, healing lesions, and reducing flare-ups.
First-Line Medical Treatments
For individuals experiencing symptoms, the initial treatment involves medications applied directly to the affected areas inside the mouth. Topical corticosteroids are the primary therapy used to control inflammation. These medications, including formulations like clobetasol and triamcinolone acetonide, suppress the local immune response, reducing swelling and discomfort. They are available as adhesive pastes, gels, or rinses for direct application.
These corticosteroid preparations are applied two to three times per day, often after meals and before bedtime to maximize contact time. The type and strength of the corticosteroid are chosen based on the severity of symptoms and lesions. Their use requires careful application to minimize absorption into the body and prevent side effects like oral candidiasis, a yeast infection.
Should topical corticosteroids prove ineffective, topical calcineurin inhibitors are the next option. This class of medication includes tacrolimus and pimecrolimus, which modulate the immune system through a different mechanism than steroids. They are useful for stubborn, erosive lesions that have not responded to steroid therapy. Applied as an ointment or cream, these inhibitors reduce inflammation and help heal painful sores, though they may cause a temporary burning sensation.
Advanced or Systemic Medical Treatments
When oral lichen planus is severe or does not respond to topical treatments, medications that work throughout the body may be prescribed. These systemic therapies are for more challenging cases. Systemic corticosteroids, such as prednisone in pill form, are used to gain rapid control over acute flare-ups. This treatment is prescribed for short durations, with the dose tapered to minimize side effects.
For long-term management of persistent cases, other systemic drugs that modify the immune system may be used. Medications like azathioprine, methotrexate, or mycophenolate mofetil are immunosuppressants that reduce the underlying inflammation. Using these medications allows the corticosteroid dose to be lowered or discontinued for safer extended use.
Because these advanced treatments affect the entire immune system, they carry a higher risk of side effects than topical options. Patients undergoing systemic therapy require close monitoring by a specialist, which includes regular blood tests to check for impacts on the liver and blood cell counts. The decision to use these medications involves weighing their benefits against potential risks.
Supportive Home Care and Trigger Management
Alongside medical treatments, home care practices can help manage symptoms and reduce flare-ups. Gentle oral hygiene is important to prevent irritation of sensitive mouth tissues. This includes using a soft-bristled toothbrush and avoiding toothpastes with harsh detergents like sodium lauryl sulfate. Regular cleaning helps control plaque and prevent secondary infections.
Dietary choices also play a role in managing the condition, as certain foods can trigger or worsen pain from oral lesions. Patients are advised to avoid spicy foods, acidic items like citrus fruits and tomatoes, and beverages such as coffee. Coarse or sharp foods, like crusty bread and chips, can injure the lesions and should be avoided during flare-ups.
Managing stress is another component of supportive care, as emotional stress is a known trigger for flare-ups in many individuals. While the direct mechanism is complex, stress can influence the body’s inflammatory responses. Engaging in stress-reduction techniques such as mindfulness, meditation, or gentle exercise can help stabilize the condition and decrease symptom severity.
Monitoring and Professional Follow-Up
Oral lichen planus is a chronic condition that requires ongoing management and regular professional oversight. Consistent follow-up appointments with a dentist, oral medicine specialist, or dermatologist are an important part of the long-term care plan. These visits allow the provider to evaluate treatment effectiveness and observe the behavior of the lesions. Adjustments to medications can be made based on these observations.
This continuous monitoring extends beyond symptom management, serving as a screening process for any changes in the lesions. This is important because, in a small percentage of cases, areas affected by erosive oral lichen planus have a slightly increased risk of developing oral cancer over many years.
Regular examinations enable the early detection of any suspicious tissue changes, which is why professional follow-up is recommended even when symptoms are mild. A biopsy, where a small tissue sample is taken for microscopic examination, may be performed if any areas look concerning. This proactive approach helps ensure that potential complications are identified and addressed early.