The lesions
of oral lichen planus appear, regress, and reappear in a somewhat unpredictable
fashion.
Major researchers calculated that 41 percent of reticular lesions healed
spontaneously whereas 12 percent of the atrophic, 7 percent of the plaque
like lesions, and none of the erosive group healed without treatment.
Chronic
oral lichen planus often loses the characteristic reticular feature,
and atrophic and plaque like changes becomes more important.
Thorn and coworkers also confirmed that long-term topical steroid and
antimycoctic therapy had no apparent effect on the course of the disease.
Lesions
are usually too diffuse for surgical removal, although cryotherapy and
cauterization have been used. Surgical excision also has a place in
the treatment of long standing erosive lesions.
Symptomatic treatment of oral lesions can be provided by topical analgesics
or anti histamane rinses, or more specifically by use of topical corticosteroids.
Topical corticosteroids promote healing of erosive areas but do not
eliminate reticular popular or plaque like changes of lichen planus.
Various corticosteroids have been used, including hydrocorticosone,
prednisolone.
Prednisone, betamethasone and beclomethosone, triamcinolone and fluocinonide,
applied in either gel, cream, oral solution or aerosol formulations.
Side effects of this treatment are minimal, and prolonged use of topical
oral steroids without an occlusive dressing does not usually lead to
any detectable adrenocortical auppression, other than in increased blood
sugar level in known diabetics.
When applied unrestrictedly by the patient under a gingival stent or
denture, however, absorption is greatly increased and may lead to clinical
signs of adrenocortical suppression.
Candida overgrowth with clinical thrush may also develop, requiring
concomitant topical or systemic antifungal therapy. Weekly intralesional
injections of triamcinolone acetonide.
Triamcinolone diacetate, or other injectable hydrocortisone or prednisolone
solution are useful in healing nonresponsive and extensively eroded
areas of mucosa, the pain of the injection may be controlled by injecting
the steroid in a 50 percent mixture with lidocaine.
No more than two or three injections are usually required and healing
of the previously ulcerated site occurs in 5 to 7 days, if the injections
are well spaced and encompass the entire lesion.
Retinoids are also useful, usually in conjunction with topical corticosteroids
as adjunctive therapy for oral lichen planus.The lesions of oral lichen
planus appear, regress, and reappear in a somewhat unpredictable fashion.
There is no specific treatment for lichen planus. In the past, such
compounds as arsenicals, mercurials and bismuth were used, but with
only indifferent success.
Although vitamin therapy has been advocated with some reported benefit,
the value of such therapy is difficult to estimate. Corticosteroid therapy
has been used in severe cases to relieve the inflammation and decrease
the pruritus of skin lesions.
The intraoral lesions also respond to corticosteroids, especially intralesional
administration. This is particularly indicated in the erosive form or
when there is significant pain.
It is not uncommon for the disease to regress completely after stabilization
of the emotional state of the patient.
Malignant
potential:
Lichen planus, at one time, was thought to be a perfectly benign disease
and was not considered a potentially premalignant condition. However,
there has been a relatively large number of cases of epidermoid carcinoma
developing in oral lesions of lichen planus reported in the literature.
In as much of both oral lichen planus and oral cancer are relatively
common diseases, their simultaneous occurrence in the same patient at
least in some cases may only be fortuitous.
Nevertheless, the possibility of a true relationship between these two
diseases, albeit quite a limited one, must be accepted pending clarification
through further study.
Interestingly and perhaps significantly, the majority of these reported
cases of cancer have occurred in the erosive type of lichen planus.
An analogous malignant transformation of dermal lichen planus has been
reported but is very rare.
