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Lichen planus of gingiva — Clinical Guidelines

Overview

Lichen planus of the gingiva is a chronic inflammatory and immune-mediated condition affecting mucous membranes, particularly the oral cavity, alongside potential involvement of skin, nails, and other mucosae 1 3.

Diagnosis

Clinical presentation includes reticular, atrophic, or erosive lesions in the oral mucosa 2.

Histopathological examination confirms characteristic features such as hyperkeratosis, acanthosis, and band-like lymphocytic infiltration at the dermo-epidermal junction 2 3.

Biopsy is essential for definitive diagnosis, especially distinguishing from other lichenoid reactions 2.

Management

First-line treatments: Topical corticosteroids (e.g., fluocinonide) and calcineurin inhibitors (e.g., pimecrolimus) for mild to moderate cases 2 3.

Adjunctive therapies: Systemic corticosteroids for severe or refractory cases, possibly combined with immunosuppressants like methotrexate or mycophenolate mofetil 1 3.

Other options: Phototherapy (e.g., PUVA) may be considered in resistant cases 13.

Special Populations

Comorbidities: Patients with erosive lichen planus may have an association with chronic liver disease, particularly cirrhosis and hepatitis 10 15.

Vitamin status: Correction of vitamin deficiencies, particularly B1 and B6, can lead to clinical improvement, though not complete remission 16.

Key Recommendations

Biopsy for definitive diagnosis: Essential for confirming lichen planus and differentiating from other conditions 2 3 (Evidence: Strong).

Topical corticosteroids as first-line: Effective for managing mild to moderate oral lichen planus 2 3 (Evidence: Moderate).

Consider systemic therapy for severe cases: Use systemic corticosteroids or immunosuppressants in refractory or severe presentations 1 3 (Evidence: Moderate).

Monitor for comorbidities: Screen patients with erosive lichen planus for underlying liver disease 10 15 (Evidence: Moderate).

Address nutritional deficiencies: Evaluate and correct vitamin deficiencies, especially B1 and B6, to support overall management 16 (Evidence: Moderate).

References

1 Pawlowski J, Beczinski J, Stege H, Mann C, Butsch F, Al-Nawas B et al.. Bridging the gaps: management of lichen planus subtypes in a joint dermatology-oral surgery clinic. Clinical and experimental dermatology 2023. link 2 Erthal A, Lourenço SV, Nico MMS. Oral lichen planus: case series and experience in a tertiary dermatology service in Brazil. Anais brasileiros de dermatologia 2023. link 3 Ioannides D, Vakirlis E, Kemeny L, Marinovic B, Massone C, Murphy R et al.. European S1 guidelines on the management of lichen planus: a cooperation of the European Dermatology Forum with the European Academy of Dermatology and Venereology. Journal of the European Academy of Dermatology and Venereology : JEADV 2020. link 4 Iorizzo M, Tosti A, Starace M, Baran R, Daniel CR, Di Chiacchio N et al.. Isolated nail lichen planus: An expert consensus on treatment of the classical form. Journal of the American Academy of Dermatology 2020. link 5 Lai YC, Yew YW. Lichen planus and lichenoid drug eruption after vaccination. Cutis 2017. link 6 Webster G. Failure of lichen planopilaris to respond to ustekinumab. Dermatology online journal 2015. link 7 Salaria SN, Abu Alfa AK, Cruise MW, Wood LD, Montgomery EA. Lichenoid esophagitis: clinicopathologic overlap with established esophageal lichen planus. The American journal of surgical pathology 2013. link 8 Fox LP, Lightdale CJ, Grossman ME. Lichen planus of the esophagus: what dermatologists need to know. Journal of the American Academy of Dermatology 2011. link 9 Verma SB. Striae: stretching the long list of precipitating factors for 'true koebnerization' of vitiligo, lichen planus and psoriasis. Clinical and experimental dermatology 2009. link 10 Strauss RA, Fattore L, Soltani K. The association of mucocutaneous lichen planus and chronic liver disease. Oral surgery, oral medicine, and oral pathology 1989. link90137-0) 11 Tosti A, De Padova MP, Fanti P. Nail involvement in lichen planopilaris. Cutis 1988. link 12 Nordlind K, Lagerholm B, Hast R, Strand A. Bone marrow investigation in patients with lichen planus. Dermatologica 1986. link 13 Naukkarinen A, Väätäinen N, Syrjänen KJ, Horsmanheimo M. Immunophenotyping of the dermal cell infiltrate in lichen planus treated with PUVA. Acta dermato-venereologica 1985. link 14 Rudolph RI. Lichen aureus. Journal of the American Academy of Dermatology 1983. link70087-3) 15 Rebora A, Patri P, Rampini E, Crovato F, Ciravegna G, Rebora A et al.. Erosive lichen planus and cirrhotic hepatitis. Italian general review of dermatology 1978. link 16 Jolly M, Nobile S. Vitamin status of patients with oral lichen planus. Australian dental journal 1977. link

Lichen planus of gingiva