Materiały źródłowe

• #1 Oral Lichen Planus: A Narrative Review Navigating Etiologies, Clinical Manifestations, Diagnostics, and Therapeutic Approaches

  https://www.mdpi.com/2077-0383/13/17/5280

  Oral Lichen Planus (OLP) is a common immune-mediated inflammatory disorder affecting the oral mucosa, impacting 0.5% to 2% of the global population, primarily middle-aged women. […] The World Health Organization (WHO) classifies OLP as a potentially malignant disorder, with a risk of oral squamous cell carcinoma (OSCC) developing in up to 2% of lesions. […] Diagnosis relies on clinical examination, histopathology, and direct immunofluorescence. […] Recent advancements in diagnostic markers and imaging techniques have improved detection and monitoring. […] Regular screenings and biopsies are essential due to OLP’s likelihood of malignant transformation. […] The primary aim of this review is to provide a comprehensive exploration of the latest insights into the factors contributing to the development of OLP, the diagnostic methods and techniques, and the various strategies for effectively managing this complex oral disorder.

• #2 Oral Lichen Planus – ENT Health

  https://www.enthealth.org/conditions/oral-lichen-planus/

  Oral lichen planus is a disease of chronic inflammation in the mouth. It affects one to two percent of adults, usually after the age of 40. […] People with oral lichen planus have an elevated risk of developing oral cancer. Therefore, its important for patients with this condition to consult their primary care physician about possibly establishing care with an ENT (ear, nose, and throat) specialist, or otolaryngologist. […] The ultimate cause of oral lichen planus is unknown. It appears to be an autoimmune disease in which T-cells trigger destruction in the cells that line the mouth. […] If stress and anxiety are worsening your condition, consider speaking with someone who can help you bring these conditions under control. […] To reduce your risk of developing oral cancer, do not smoke, do not chew betel, and moderate your consumption of alcohol. See your ENT specialist again if your oral lesions start to change or look different.

• #3 Oral Lichen Planus: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17875-oral-lichen-planus

  Oral lichen planus (OLP) is a condition that causes inflammation inside your mouth. […] A healthcare provider can diagnose oral lichen planus by examining your mouth. In many cases, providers take a tissue biopsy to confirm the diagnosis and rule out other diseases. […] Treatment for OLP focuses on reducing symptoms and preventing flare-ups. This means you may not need treatment if you dont have symptoms that are bothering you. […] Once youre diagnosed with oral lichen planus, youll need regular check-ups to keep tabs on your condition. This is the case even if youre going through a period with no symptoms. […] Oral lichen planus can be mistaken for a yeast infection in your mouth (thrush) and leukoplakia. Like OLP, both involve white patches or spots in your mouth. But their causes are different, and so are their treatments. A healthcare provider will do tests to find out which condition you have.

• #4 Oral Lichen Planus | IntechOpen

  https://www.intechopen.com/chapters/45384

  Lichen planus is a chronic systemic disease of established immune-mediated pathogenesis. It most commonly, protractedly and persistently, involves the mucosa of the oral cavity, but it can involve other sites, namely the skin, the scalp (with inflammation around and affecting the hair follicles) resulting in alopecia), the nails as well as the genital area – the vulval and vaginal mucosa, and the glans penis. Other sites of involvement that are far less frequently described include the oesophagus and conjunctiva. There are seven recognized oral presentations of lichen planus: (1) reticular, (2) papular, and (3) plaque-form and the (4) atrophic, (5) ulcerative (erosive) and rare (6) vesiculo-bullous form and (7) desquamative gingivitis, this latter term is a clinical descriptor, used to describe inflammation, with a mix of erythema, erosion and/or ulceration of the gingival tissues and the immediately adjacent alveolar mucosa, not incited by the presence of dental bacterial plaque. These latter four forms of OLP can be associated with significant discomfort requiring either topical and/or systemic immunosuppressive therapy.

• #5 Oral Lichen Planus: Symptoms, Causes & Treatment | Colgate®

  https://www.colgate.com/en-us/oral-health/mouth-sores-and-infections/oral-lichen-planus-symptoms-causes-treatment

  Diagnosing oral lichen planus requires a clinician to thoroughly review the patient’s medical history. That includes any medications taken and a detailed clinical oral and physical examination. If the diagnosis is inconclusive, a biopsy of the tissue or a swab culture of the affected area may be needed. Clinical monitoring is essential since there is a slight risk of developing oral cancer (medically known as squamous cell carcinoma).

• #6 Lichen planus – Wikipedia

  https://en.wikipedia.org/wiki/Lichen_planus

  Oral lichen planus (also termed oral mucosal lichen planus), is a form of mucosal lichen planus, where lichen planus involves the oral mucosa, the lining of the mouth. This may occur in combination with other variants of lichen planus. Six clinical forms of oral lichen planus (OLP) are recognized: […] A diagnosis of oral lichen planus (LP) is confirmed through review of the patient history, physical examination, and histologic findings. […] Tissue biopsies of oral LP help to confirm the diagnosis and are particularly of value for erythematous and erosive LP, which share features with multiple other mucosal disorders, including oral malignancy. Biopsies to confirm oral LP are less essential in patients who present with classic reticular LP, particularly in patients in whom a diagnosis of LP has already been confirmed through biopsy of an extraoral manifestation of this disorder.

• #7 Oral Lichen Planus | IntechOpen

  https://www.intechopen.com/chapters/45384

  Lichen planus is a chronic systemic disease of established immune-mediated pathogenesis. It most commonly, protractedly and persistently, involves the mucosa of the oral cavity, but it can involve other sites, namely the skin, the scalp (with inflammation around and affecting the hair follicles) resulting in alopecia), the nails as well as the genital area – the vulval and vaginal mucosa, and the glans penis. Other sites of involvement that are far less frequently described include the oesophagus and conjunctiva. There are seven recognized oral presentations of lichen planus: (1) reticular, (2) papular, and (3) plaque-form and the (4) atrophic, (5) ulcerative (erosive) and rare (6) vesiculo-bullous form and (7) desquamative gingivitis, this latter term is a clinical descriptor, used to describe inflammation, with a mix of erythema, erosion and/or ulceration of the gingival tissues and the immediately adjacent alveolar mucosa, not incited by the presence of dental bacterial plaque. These latter four forms of OLP can be associated with significant discomfort requiring either topical and/or systemic immunosuppressive therapy.

• #8 Oral Lichen Planus | Ento Key

  https://entokey.com/oral-lichen-planus/

  Oral lichen planus (OLP) is a chronic, immune-mediated condition commonly affecting middle-aged women. […] Strict clinical and histologic criteria need to be met to arrive at a definite diagnosis, thereby ruling out other conditions that may mimic OLP clinically and/or histologically. […] The diagnosis of OLP is made based on a strict combination of clinical criteria as well as histopathologic evaluation. […] To better define the criteria for diagnosis of OLP, the World Health Organization (WHO) devised a set of clinicopathologic criteria in 1978. […] In addition, knowledge about history of systemic diseases, history of drug use, and cutaneous lesions can be helpful in arriving at a definite diagnosis. […] A diagnosis of OLP requires fulfillment of clinical and histopathologic criteria.

• #9 Oral lichen planus: Management and prognosis – UpToDate

  https://www.uptodate.com/contents/oral-lichen-planus-management-and-prognosis

  Oral lichen planus (LP) is a mucosal subtype of LP that presents with a variety of clinical features. Clinical subtypes include reticular oral LP (white striations, papules, and plaques), erythematous (atrophic) oral LP (mucosal atrophy and red patches), and erosive oral LP (erosions or ulcers) (picture 1A-B). […] The management and prognosis of oral LP, including the association with risk for oral squamous cell carcinoma (SCC), will be reviewed here. The clinical features and diagnosis of oral LP are discussed separately. […] (See „Oral lichen planus: Pathogenesis, clinical features, and diagnosis.”)

• #10 Oral lichenplanus: Etiology, pathogenesis, diagnosis, and management

  https://www.wjgnet.com/2218-6263/full/v4/i1/12.htm

  Oral lichen planus (OLP) is a disease of unknown etiology affecting stratified squamous epithelia. […] The purpose of this review is to provide an update of the etiopathogenesis, clinical features, histological features, Diagnosis and management of OLP. […] The diagnosis can be made depending on the history, clinical and histopathological examination. […] However, in classical lesions, the diagnosis can be arrived based on clinical appearances (Wickhams striae, erythematous area) only. […] Biopsy is the gold standard for the diagnosis of OLP. […] Direct and indirect immunofluorescent studies, direct oral microscopy and enzyme linked immunosorbent assays can be helpful in reaching a diagnosis for problematic cases and to exclude malignancy. […] The histopathological features of OLP are characterized by a dense sub-epithelial lympho-histiocytic infiltrate, increased numbers of intra-epithelial lymphocytes and degeneration of basal keratinocytes.

• #11 SciELO Brazil – Líquen plano oral (LPO): diagnóstico clínico e complementar Líquen plano oral (LPO): diagnóstico clínico e complementar

  https://www.scielo.br/j/abd/a/3HPq5z8Gdjsp4PgjQRwmLZP/?lang=en

  Lichen planus is a common disorder of the stratified squamous epithelium that affects oral and genital mucous membranes, skin, nails, and scalp. Oral Lichen Planus (OLP) affects middle-aged women and shows distribution patterns and characteristics such as white striations, white plaques or papules, erythema, blisters and erosions, and may be associated with medication and/or dental materials used by the patient. The clinical diagnosis can only be made if the disease presents classical patterns such as concomitant lesions in the oral mucosa and skin. […] The diagnosis of oral lichen planus (OLP) should be done by clinical and histological examination. However, in classical lesions, it is possible to achieve the diagnosis based solely on clinical appearance. […] The diagnosis of OLP is usually achieved by clinical and histological examination. Nevertheless, in classical lesions (bilateral white striae in the mucosa of the cheek), it is possible to accomplish the diagnosis based solely on clinical appearance. Differential diagnosis includes lichenoid reactions to drugs or dental materials, leukoplakia, lupus erythematosus, and graft vs. host disease in bone marrow transplantation patients. Desquamative gingivitis may also be mistaken for other diseases, such as pemphigus, pemphigoid, dermatitis herpetiformis or linear IgA disease. Therefore, complementary exams are essential for the diagnosis and exclusion of malignancy in all the cases.

• #12 Oral lichenplanus: Etiology, pathogenesis, diagnosis, and management

  https://www.wjgnet.com/2218-6263/full/v4/i1/12.htm

  Oral lichen planus (OLP) is a disease of unknown etiology affecting stratified squamous epithelia. […] The purpose of this review is to provide an update of the etiopathogenesis, clinical features, histological features, Diagnosis and management of OLP. […] The diagnosis can be made depending on the history, clinical and histopathological examination. […] However, in classical lesions, the diagnosis can be arrived based on clinical appearances (Wickhams striae, erythematous area) only. […] Biopsy is the gold standard for the diagnosis of OLP. […] Direct and indirect immunofluorescent studies, direct oral microscopy and enzyme linked immunosorbent assays can be helpful in reaching a diagnosis for problematic cases and to exclude malignancy. […] The histopathological features of OLP are characterized by a dense sub-epithelial lympho-histiocytic infiltrate, increased numbers of intra-epithelial lymphocytes and degeneration of basal keratinocytes.

• #13 Diagnosis and Treatment of Lichen Planus | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0701/p53.html

  Lichen planus can be diagnosed clinically in classic cases, although biopsy is often helpful to confirm the diagnosis and is required for more atypical presentations. A 4-mm punch biopsy should be adequate on the skin or in the mouth. The histology shows a characteristic saw-tooth pattern of epidermal hyperplasia; hyperparakeratosis with thickening of the granular cell layer; and vacuolar alteration of the basal layer of the epidermis, with an intense infiltration (mainly T cells) at the dermal-epidermal junction. […] A 4-mm punch biopsy of perilesional skin for direct immunofluorescence may be added to the workup when bullous lesions, pemphigus, or bullous pemphigoid is present. […] Topical corticosteroids are first-line therapy for mucosal erosive lichen planus. […] Systemic corticosteroids, such as oral prednisone, should be considered only for severe, widespread oral lichen planus and for lichen planus involving other mucocutaneous sites.

• #14 Diagnostic Criteria of Oral Lichen Planus: A Narrative Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8212651/

  Significant changes have been made over years concerning the diagnosis of OLP. According to the WHO, there is a lack of clinical and histologic criteria for both OLP and OLL. […] The clinical (history and presentation), histopathologic, immunofluorescence, biomarkers, reflectance confocal microscopy, fluorescence spectroscopy, and/or therapeutic probation features detailed below support the diagnosis of OLP and OLL. […] Diagnosis of OLP is established by clinical examination with histopathologic confirmation. Direct immunofluorescence examination is used to rule out particular autoimmune diseases (e.g., pemphigus, pemphigoid). […] Histopathologic diagnosis confirms the clinical diagnosis of OLP. The correlation between clinical and histopathologic diagnosis is crucial for definitive diagnosis of OLP. OLP necessitates additional biopsy for direct immunofluorescence assessment and/or histopathologic evaluation, so continued clinical follow-up after the initial biopsy is essential. […] Oral lichenoid lesions must be distinguished from OLP by two factors. First, the association with the administration of a drug, contact with a metal or foodstuff, or presence of a systemic disease must be verified. Second, elimination of the offending agent leads to resolution of the OLL.

• #15 Oral Lichen Planus (OLP) Laboratory Testing | Beutner Labs

  https://www.beutnerlabs.com/oral-lichen-planus-olp-laboratory-testing

  Diagnosis of OLP is established by clinical examination with histopathologic confirmation. Direct immunofluorescence (DIF) examination is used to rule out autoimmune diseases (e.g., pemphigus, pemphigoid). Histopathologic diagnosis confirms the clinical diagnosis of OLP. The correlation between clinical and histopathologic diagnosis is crucial for definitive diagnosis of OLP. OLP necessitates additional biopsy for direct immunofluorescence assessment and/or histopathologic evaluation, so continued clinical follow-up after the initial biopsy is essential. […] The histopathologic features of OLP are characteristic and composed of hyperkeratosis of the epithelium, hydropic or liquefaction degeneration of basal epithelial cells, atrophy or acanthosis of spinous epithelial cells, saw-tooth epithelial ridges, a homogeneous eosinophilic deposit at the epithelium-connective tissue junction, and a band-like lymphocytic infiltrate in the superficial lamina propria.

• #16 Oral Lichen Planus Workup: Laboratory Studies, Other Tests, Procedures

  https://emedicine.medscape.com/article/1078327-workup

  Histopathologic examination of lesional tissue is the most relevant investigation in cases of OLP. It should be appreciated that good biopsy technique and appropriate handling are extremely important for achieving an accurate pathologic diagnosis. […] Consistent findings include a bandlike subepithelial mononuclear infiltrate consisting of T cells and histiocytes, increased numbers of intraepithelial T cells, and degenerating basal keratinocytes that form colloid (Civatte, hyaline, cytoid) bodies, which appear as homogenous eosinophilic globules. […] In OLP, electron microscopy is used principally as a research tool. The ultrastructure of the colloid bodies suggests that they are apoptotic keratinocytes, and studies using the end-labeling method have revealed DNA fragmentation in these cells.

• #17 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Lichen-Planus-Diagnosis.aspx

  Diagnosis of lichen planus is based on clinical grounds, namely, the appearance of the rash in the oral cavity or on the skin. Oral lichen planus lesions are often picked up first by dentists during routine dental check-ups. […] In some cases, patients with oral lichen planus present with cutaneous lesions, and the oral lesions are found only on examination. Genital lesions are present in up to 25% of women with oral lichen planus, but only up to 4% of men with similar location of lesions. […] In atypical cases of cutaneous lichen planus, the rash may be confused with other conditions, such as: […] In some cases, oral lichen planus may be mistaken for: […] The most common test is a 4-mm punch biopsy from an affected area, either on the skin or in the mouth. The most common pattern seen on microscopic examination of the biopsy is a saw-tooth pattern due to hyperplasia of the epidermis. There is a T-cell infiltrate at the dermo-epidermal junction, with vacuolar or liquefactive degeneration of the basal cells of the epidermis. The granular cell layer is thickened.

• #18 Oral Lichen Planus | Ento Key

  https://entokey.com/oral-lichen-planus/

  The oral manifestations of OLP have been described in many large studies. […] Histologic confirmation of the diagnosis is thus required. […] The histologic features of OLP were first described by Dubreuill in 1906 and later revised by Shklar in 1972. […] The WHO developed a set of histopathological criteria for OLP in 1978, which was most recently modified in 2003. […] Definite diagnostic histologic findings include liquefactive degeneration of the basal cells, colloid bodies (Civatte, hyaline, cytoid), homogeneous infiltrate of lymphocytes in a dense, bandlike pattern along the epithelium-connective tissue interface in the superficial dermis, cytologically normal maturation of the epithelium, sawtooth rete ridges, and hyperkeratosis (orthokeratosis or parakeratosis). […] Several histologic criteria that are considered as exclusionary in diagnosing OLP include the absence of basal cell liquefaction degeneration, polyclonal inflammatory infiltrate, abnormal cytology suggestive of dysplasia, abnormal keratinization, flat rete ridges, and absence of colloid bodies.

• #19 Diagnosis and Treatment of Lichen Planus | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0701/p53.html

  Lichen planus can be diagnosed clinically in classic cases, although biopsy is often helpful to confirm the diagnosis and is required for more atypical presentations. A 4-mm punch biopsy should be adequate on the skin or in the mouth. The histology shows a characteristic saw-tooth pattern of epidermal hyperplasia; hyperparakeratosis with thickening of the granular cell layer; and vacuolar alteration of the basal layer of the epidermis, with an intense infiltration (mainly T cells) at the dermal-epidermal junction. […] A 4-mm punch biopsy of perilesional skin for direct immunofluorescence may be added to the workup when bullous lesions, pemphigus, or bullous pemphigoid is present. […] Topical corticosteroids are first-line therapy for mucosal erosive lichen planus. […] Systemic corticosteroids, such as oral prednisone, should be considered only for severe, widespread oral lichen planus and for lichen planus involving other mucocutaneous sites.

• #20 Integrative Approaches for the Diagnosis and Management of Erosive Oral Lichen Planus

  https://www.mdpi.com/2075-4418/14/7/692

  Erosive oral lichen planus (EOLP) represents a significant challenge in dental and medical management due to its chronic inflammatory nature, painful symptoms, and impact on quality of life. […] The diagnosis of erosive oral lichen planus (EOLP) is primarily clinical and relies on the appearance of the lesions and associated symptomatology and their progression over time. While a microscopic examination can provide supporting evidence for the diagnosis, its principal purpose is the identification of potential malignant transformation of suspicious lesions. When conducting microscopic examinations, it is crucial to obtain samples from the periphery of EOLP lesions for optimal diagnostic accuracy. […] The diagnosis of erosive oral lichen planus (EOLP) is primarily clinical, requiring a thorough examination and a detailed patient history to distinguish it from similar mucosal conditions. Key diagnostic features include the presence of painful, erythematous lesions with ulcerations, often accompanied by Wickham’s striae on the mucosa.

• #21 Oral lichenplanus: Etiology, pathogenesis, diagnosis, and management

  https://www.wjgnet.com/2218-6263/full/v4/i1/12.htm

  Absence of basal cell liquefaction, atypical cytomorphology, heterogeneous population of infiltrate, nucleus enlargement, blunted rete ridges, increased mitotic figures, absence of civatte bodies, abnormal keratinization will help to rule out the definitive diagnosis of OLP. […] Direct Immunofluorescent examination of tissue in case of OLP demonstrates deposition of fibrinogen along the basement membrane zone. […] The sensitivity of direct immunofluorescence is positive for 65.8% of the patients with OLP. […] Direct oral microscopy technique is noninvasive which helps in clinical examination of oral cavity. […] The inflammatory component of OLP is treated with various above mentioned methods and additional approaches are required for assessing and treating dysplastic component in these cases. […] Therefore early diagnosis and treatment is mandatory with periodical follow up of the patients.

• #22 Oral lichenplanus: Etiology, pathogenesis, diagnosis, and management

  https://www.wjgnet.com/2218-6263/full/v4/i1/12.htm

  Absence of basal cell liquefaction, atypical cytomorphology, heterogeneous population of infiltrate, nucleus enlargement, blunted rete ridges, increased mitotic figures, absence of civatte bodies, abnormal keratinization will help to rule out the definitive diagnosis of OLP. […] Direct Immunofluorescent examination of tissue in case of OLP demonstrates deposition of fibrinogen along the basement membrane zone. […] The sensitivity of direct immunofluorescence is positive for 65.8% of the patients with OLP. […] Direct oral microscopy technique is noninvasive which helps in clinical examination of oral cavity. […] The inflammatory component of OLP is treated with various above mentioned methods and additional approaches are required for assessing and treating dysplastic component in these cases. […] Therefore early diagnosis and treatment is mandatory with periodical follow up of the patients.

• #23 Diagnostic Criteria of Oral Lichen Planus: A Narrative Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8212651/

  Significant changes have been made over years concerning the diagnosis of OLP. According to the WHO, there is a lack of clinical and histologic criteria for both OLP and OLL. […] The clinical (history and presentation), histopathologic, immunofluorescence, biomarkers, reflectance confocal microscopy, fluorescence spectroscopy, and/or therapeutic probation features detailed below support the diagnosis of OLP and OLL. […] Diagnosis of OLP is established by clinical examination with histopathologic confirmation. Direct immunofluorescence examination is used to rule out particular autoimmune diseases (e.g., pemphigus, pemphigoid). […] Histopathologic diagnosis confirms the clinical diagnosis of OLP. The correlation between clinical and histopathologic diagnosis is crucial for definitive diagnosis of OLP. OLP necessitates additional biopsy for direct immunofluorescence assessment and/or histopathologic evaluation, so continued clinical follow-up after the initial biopsy is essential. […] Oral lichenoid lesions must be distinguished from OLP by two factors. First, the association with the administration of a drug, contact with a metal or foodstuff, or presence of a systemic disease must be verified. Second, elimination of the offending agent leads to resolution of the OLL.

• #24 Lichen planus: Diagnosis and treatment

  https://www.aad.org/public/diseases/a-z/lichen-planus-treatment

  Your dermatologist can often diagnose lichen planus by: […] Some patients also need a: Skin biopsy: To do this, your dermatologist removes a small sample from your rash, so that it can be examined under a microscope. […] If the diagnosis is lichen planus, your dermatologist will decide whether you need treatment. […] When lichen planus affects the mouth, its called oral lichen planus. If you have a mild form, you may not need treatment. Mild disease tends to go away on its own in time. […] If oral lichen planus is causing a burning sensation in your mouth, painful ulcers, or rawness, treatment is recommended. A treatment plan typically includes: […] Medication that works throughout the body: If you have symptoms, such as painful sores or erosions in your mouth, you may need an oral (take by mouth) corticosteroid like prednisone or an oral retinoid like isotretinoin.

• #25 SciELO Brazil – Líquen plano oral (LPO): diagnóstico clínico e complementar Líquen plano oral (LPO): diagnóstico clínico e complementar

  https://www.scielo.br/j/abd/a/3HPq5z8Gdjsp4PgjQRwmLZP/?lang=en

  Lichen planus is a common disorder of the stratified squamous epithelium that affects oral and genital mucous membranes, skin, nails, and scalp. Oral Lichen Planus (OLP) affects middle-aged women and shows distribution patterns and characteristics such as white striations, white plaques or papules, erythema, blisters and erosions, and may be associated with medication and/or dental materials used by the patient. The clinical diagnosis can only be made if the disease presents classical patterns such as concomitant lesions in the oral mucosa and skin. […] The diagnosis of oral lichen planus (OLP) should be done by clinical and histological examination. However, in classical lesions, it is possible to achieve the diagnosis based solely on clinical appearance. […] The diagnosis of OLP is usually achieved by clinical and histological examination. Nevertheless, in classical lesions (bilateral white striae in the mucosa of the cheek), it is possible to accomplish the diagnosis based solely on clinical appearance. Differential diagnosis includes lichenoid reactions to drugs or dental materials, leukoplakia, lupus erythematosus, and graft vs. host disease in bone marrow transplantation patients. Desquamative gingivitis may also be mistaken for other diseases, such as pemphigus, pemphigoid, dermatitis herpetiformis or linear IgA disease. Therefore, complementary exams are essential for the diagnosis and exclusion of malignancy in all the cases.

• #26 Oral lichen planus and lichenoid lesions – challenges and pitfalls for the general dental practitioner | British Dental Journal

  https://www.nature.com/articles/s41415-024-7063-y

  It has been suggested that a diagnosis of OLP can be made in asymptomatic patients with typical reticular and bilateral buccal striations without the need for a biopsy. […] The role of histopathology in discerning OLP from OLLs can be very limited due to the mostly indistinguishable features. […] However, subtle histological differences that may be identified include deep perivascular lymphocytic infiltrate in oral lupus, and even in lichenoid reactions. […] A small proportion of OLP and OLLs demonstrate malignant transformation to oral squamous cell carcinoma (0.5-2.5% over five years). […] The malignant potential of OLP and OLLs has been long debated, but a recent consensus report by the WHO Collaborating Centre for Oral Cancer has listed both OLP and OLLs as potentially malignant disorders.

• #27 Diagnostic Criteria of Oral Lichen Planus: A Narrative Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8212651/

  Significant changes have been made over years concerning the diagnosis of OLP. According to the WHO, there is a lack of clinical and histologic criteria for both OLP and OLL. […] The clinical (history and presentation), histopathologic, immunofluorescence, biomarkers, reflectance confocal microscopy, fluorescence spectroscopy, and/or therapeutic probation features detailed below support the diagnosis of OLP and OLL. […] Diagnosis of OLP is established by clinical examination with histopathologic confirmation. Direct immunofluorescence examination is used to rule out particular autoimmune diseases (e.g., pemphigus, pemphigoid). […] Histopathologic diagnosis confirms the clinical diagnosis of OLP. The correlation between clinical and histopathologic diagnosis is crucial for definitive diagnosis of OLP. OLP necessitates additional biopsy for direct immunofluorescence assessment and/or histopathologic evaluation, so continued clinical follow-up after the initial biopsy is essential. […] Oral lichenoid lesions must be distinguished from OLP by two factors. First, the association with the administration of a drug, contact with a metal or foodstuff, or presence of a systemic disease must be verified. Second, elimination of the offending agent leads to resolution of the OLL.

• #28 Oral lichen planus – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/oral-lichen-planus/diagnosis-treatment/drc-20350874

  Your healthcare professional may make a diagnosis of oral lichen planus based on: […] Your healthcare professional also may request lab tests, such as: […] A biopsy. In this test, a small tissue sample is taken from one or more spots in your mouth. This sample is studied under a microscope to see if oral lichen planus is present. Other, more specialized microscopic tests may be needed to find immune system proteins commonly related to oral lichen planus. […] Blood tests. These tests may be done to find conditions such as hepatitis C, which may rarely be related to oral lichen planus, and lupus, which may look like oral lichen planus. […] Your healthcare professional will likely ask more questions based on your responses, symptoms and needs. Prepare for questions to make the most of your appointment time.

• #29 Diagnosis and management of oral lichen planus – Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8859620/

  Oral lichen planus (OLP) is an auto immune, common, chronic T-cell-mediated inflammatory disorder of the skin and mucous membranes that occurs in various clinical forms that often poses a diagnostic and therapeutic challenge due to its refractory course and relapsing nature. […] The diagnosis of an OLP may be made on visual examination without any biopsy when the lesion presents with the characteristic Wickham’s striae. […] A complete history and clinical assessment by various specialists such as dermatologist, ophthalmic surgeon, general physician and gastroenterologist may be required to investigate the involvement other than oral cavity. […] The investigations include (1) cytology, (2) hematology and (3) biopsy (histopathological and immunofluorescence). […] The histopathology is the gold standard method used in diagnosing OLP.

• #30 Oral Lichen Planus Workup: Laboratory Studies, Other Tests, Procedures

  https://emedicine.medscape.com/article/1078327-workup

  The history, typical oral lesions, and skin involvement are usually sufficient for diagnosing oral lichen planus (OLP), though laboratory studies and biopsy may be required in some cases. […] Direct immunofluorescence testing can help in distinguishing erosive or the rare bullous OLP from pemphigus vulgaris, benign mucous membrane pemphigoid, dermatitis herpetiformis, and linear immunoglobulin A (IgA) dermatosis. The most characteristic feature of OLP is shaggy linear fibrin distribution. […] Biopsy may be required to exclude malignancy or to differentiate between OLP and other white or chronic ulcerative oral lesions, including reactive keratoses, chronic hyperplastic candidosis, epithelial dysplasia, discoid lupus erythematosus, gastrointestinal disease (including oral Crohn disease), and anemic states.

• #31 Oral Lichen Planus (OLP) Laboratory Testing | Beutner Labs

  https://www.beutnerlabs.com/oral-lichen-planus-olp-laboratory-testing

  DIF is a diagnostic adjunct for OLP lesion. The characteristic DIF finding for OLP lesion is a deposit of fibrinogen in a shaggy pattern at the basement membrane zone in the absence of immunoglobulin and complement. DIF is often necessary to differentiate OLP from mucous membrane pemphigoid and pemphigus vulgaris.

• #32 Oral Lichen Planus (OLP) Laboratory Testing | Beutner Labs

  https://www.beutnerlabs.com/oral-lichen-planus-olp-laboratory-testing

  DIF is a diagnostic adjunct for OLP lesion. The characteristic DIF finding for OLP lesion is a deposit of fibrinogen in a shaggy pattern at the basement membrane zone in the absence of immunoglobulin and complement. DIF is often necessary to differentiate OLP from mucous membrane pemphigoid and pemphigus vulgaris.

• #33 Oral lichenplanus: Etiology, pathogenesis, diagnosis, and management

  https://www.wjgnet.com/2218-6263/full/v4/i1/12.htm

  Absence of basal cell liquefaction, atypical cytomorphology, heterogeneous population of infiltrate, nucleus enlargement, blunted rete ridges, increased mitotic figures, absence of civatte bodies, abnormal keratinization will help to rule out the definitive diagnosis of OLP. […] Direct Immunofluorescent examination of tissue in case of OLP demonstrates deposition of fibrinogen along the basement membrane zone. […] The sensitivity of direct immunofluorescence is positive for 65.8% of the patients with OLP. […] Direct oral microscopy technique is noninvasive which helps in clinical examination of oral cavity. […] The inflammatory component of OLP is treated with various above mentioned methods and additional approaches are required for assessing and treating dysplastic component in these cases. […] Therefore early diagnosis and treatment is mandatory with periodical follow up of the patients.

• #34 SciELO Brazil – Líquen plano oral (LPO): diagnóstico clínico e complementar Líquen plano oral (LPO): diagnóstico clínico e complementar

  https://www.scielo.br/j/abd/a/3HPq5z8Gdjsp4PgjQRwmLZP/?lang=en

  Among complementary exams, the most important is direct immunofluorescence, which helps in difficult cases of bullous OLP lesions that may resemble other diseases. […] The sensitivity of direct immunofluorescence depends on the disease investigated. This technique is positive for 65.8% of the patients with OLP. […] The classical histopathological characteristics must be identified for a conclusive diagnosis of OLP. They are: liquefactive degeneration of the basal layer (hydropic degeneration), band-like dense inflammatory infiltrate of T lymphocytes, normal epithelial maturation, saw-toothed anatomical prominences, Civatte bodies (coloids) and hyperkeratosis (orthokeratosis or parakeratosis). […] The malignancy potential of lichen planus, especially in the erosive form, is not yet fully understood. More concrete evidence of its malignant potential is found in long-term follow-up studies and retrospective incidence of the patients; however, the issue remains controversial.

• #35 Lichen planus – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/lichen-planus/diagnosis-treatment/drc-20351383

  To find the cause of your illness, your health care provider will likely talk with you about your symptoms and medical history and do a physical exam. You may also need some tests. These might include: […] Your health care provider removes a small piece of affected tissue for examination in a laboratory. The tissue is examined to see if it has the cell patterns typical of lichen planus. […] You may have your blood drawn to test for health problems related to lichen planus. For example, hepatitis C. […] For lichen planus, some basic questions to ask your health care provider include: Do I need any tests? […] Your health care provider is likely to ask you a number of questions, such as: Have you recently started new medicines?

• #36 Lichen planus: Symptoms, Types, and Treatment with Images — DermNet

  https://dermnetnz.org/topics/lichen-planus

  Approximately 10% of those affected have lichen planus of the nails while half of those affected have oral lichen planus, which is more common in women than in men. […] Vitamin D deficiency may be associated with oral lichen planus. Its association with other types of LP remains unexplored. […] The mouth is often the only affected area and often involves the inside of the cheeks and the sides of the tongue, but the gums and lips may also be involved. […] Patch testing may be recommended for patients with oral lichen planus affecting the gums and who have amalgam fillings, to assess for contact allergy to thiomersal (a mercurial compound) and other metals. […] In oral lichen planus, limited evidence is found in using apremilast. Successful treatment of oral and cutaneous lichen planus with adalimumab has previously been reported. Tildrakizumab has been shown to demonstrate positive results in erosive oral lichen planus in an isolated case study. […] In cases of oral lichen planus affecting the gums and buccal mucosa with contact allergy to mercury, the lichen planus may resolve on replacing the fillings with composite material. If the lichen planus is not due to mercury allergy, removing amalgam fillings is very unlikely to result in a cure.

• #37 Lichen Planus: What It Is, Causes, Types & Treatments

  https://my.clevelandclinic.org/health/diseases/17723-lichen-planus

  Your healthcare provider can typically diagnose lichen planus after assessing your symptoms and conducting a physical exam. They may look for characteristics known as the six Ps that help diagnose lichen planus: […] If there’s any doubt, your healthcare provider may perform the following tests: […] A biopsy. Your healthcare provider will use a thin blade (scalpel) or a punch tool to collect a small sample of skin from your rash. Your skin sample goes to a laboratory for testing and pathologists examines it under a microscope. […] Lichen planus is sometimes associated with the hepatitis C virus.

• #38 Diagnostic Criteria of Oral Lichen Planus: A Narrative Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8212651/

  Significant changes have been made over years concerning the diagnosis of OLP. According to the WHO, there is a lack of clinical and histologic criteria for both OLP and OLL. […] The clinical (history and presentation), histopathologic, immunofluorescence, biomarkers, reflectance confocal microscopy, fluorescence spectroscopy, and/or therapeutic probation features detailed below support the diagnosis of OLP and OLL. […] Diagnosis of OLP is established by clinical examination with histopathologic confirmation. Direct immunofluorescence examination is used to rule out particular autoimmune diseases (e.g., pemphigus, pemphigoid). […] Histopathologic diagnosis confirms the clinical diagnosis of OLP. The correlation between clinical and histopathologic diagnosis is crucial for definitive diagnosis of OLP. OLP necessitates additional biopsy for direct immunofluorescence assessment and/or histopathologic evaluation, so continued clinical follow-up after the initial biopsy is essential. […] Oral lichenoid lesions must be distinguished from OLP by two factors. First, the association with the administration of a drug, contact with a metal or foodstuff, or presence of a systemic disease must be verified. Second, elimination of the offending agent leads to resolution of the OLL.

• #39 Integrative Approaches for the Diagnosis and Management of Erosive Oral Lichen Planus

  https://www.mdpi.com/2075-4418/14/7/692

  Dermatoscopy, when applied to the oral mucosa (mucoscopy), significantly enhances the diagnostic approach to erosive oral lichen planus (EOLP). This non-invasive technique provides a magnified view of EOLP’s distinctive morphological characteristics, facilitating differentiation from similar mucosal lesions. […] A biopsy of the lesion is critical for confirming the diagnosis. Histopathological examination of hematoxylin–eosin-stained tissue samples reveals a band-like lymphocytic infiltrate just below the epithelial layer, hyperkeratosis, and sometimes, Civatte bodies (apoptotic keratinocytes). Direct immunofluorescence can further aid in diagnosis by showing fibrinogen deposits in a shaggy pattern along the basement membrane. […] While there are no specific biomarkers for EOLP, the differential diagnosis should rule out conditions such as pemphigus vulgaris, mucous membrane pemphigoid, and other forms of lichen planus affecting different body sites.

• #40 Oral lichenplanus: Etiology, pathogenesis, diagnosis, and management

  https://www.wjgnet.com/2218-6263/full/v4/i1/12.htm

  Absence of basal cell liquefaction, atypical cytomorphology, heterogeneous population of infiltrate, nucleus enlargement, blunted rete ridges, increased mitotic figures, absence of civatte bodies, abnormal keratinization will help to rule out the definitive diagnosis of OLP. […] Direct Immunofluorescent examination of tissue in case of OLP demonstrates deposition of fibrinogen along the basement membrane zone. […] The sensitivity of direct immunofluorescence is positive for 65.8% of the patients with OLP. […] Direct oral microscopy technique is noninvasive which helps in clinical examination of oral cavity. […] The inflammatory component of OLP is treated with various above mentioned methods and additional approaches are required for assessing and treating dysplastic component in these cases. […] Therefore early diagnosis and treatment is mandatory with periodical follow up of the patients.

• #41 Oral Lichen Planus Workup: Laboratory Studies, Other Tests, Procedures

  https://emedicine.medscape.com/article/1078327-workup

  Histopathologic examination of lesional tissue is the most relevant investigation in cases of OLP. It should be appreciated that good biopsy technique and appropriate handling are extremely important for achieving an accurate pathologic diagnosis. […] Consistent findings include a bandlike subepithelial mononuclear infiltrate consisting of T cells and histiocytes, increased numbers of intraepithelial T cells, and degenerating basal keratinocytes that form colloid (Civatte, hyaline, cytoid) bodies, which appear as homogenous eosinophilic globules. […] In OLP, electron microscopy is used principally as a research tool. The ultrastructure of the colloid bodies suggests that they are apoptotic keratinocytes, and studies using the end-labeling method have revealed DNA fragmentation in these cells.

• #42 Diagnosis of oral lichen planus from analysis of saliva samples using terahertz time-domain spectroscopy and chemometrics

  https://www.spiedigitallibrary.org/journals/journal-of-biomedical-optics/volume-23/issue-4/045001/Diagnosis-of-oral-lichen-planus-from-analysis-of-saliva-samples/10.1117/1.JBO.23.4.045001.full

  The ability to diagnose oral lichen planus (OLP) based on saliva analysis using THz time-domain spectroscopy and chemometrics is discussed. […] The study involved 30 patients (2 male and 28 female) with OLP. […] The control group consisted of six healthy volunteers (one male and five females) without inflammation in the mucous membrane in the oral cavity and without periodontitis. […] The two-stage classification approach using several absorption spectra scans for an individual saliva sample provided 100% accuracy of differential classification between OLP subgroups and control group. […] Histological examination of tissue remains the gold standard to identify malignant oral lesions according to morphological criteria. […] This necessitates developing more suitable diagnostic methods.

• #43 Diagnosis and management of oral lichen planus – Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8859620/

  In 1978, WHO formulated diagnostic criteria for OLP, which included both clinical and histopathological features for consideration. […] To achieve the final diagnosis, clinical as well as histopathologic criteria should be included: OLP A diagnosis of OLP requires fulfillment of both clinical and histopathological criteria. […] The non-erosive type of OLP should be differentiated from frictional keratosis, lichenoid reactions, leukoplakia and discoid lupus erythematosus both clinically and histopathologically. […] The direct immunofluorescence is applied mainly in the erosive lesions, especially desquamative gingivitis to rule out blistering diseases such as pemphigus and pemphigoids. […] Immunohistochemistry (IHC) has a limited role in the diagnosis of OLP.

• #44 Oral Lichen Planus | Ento Key

  https://entokey.com/oral-lichen-planus/

  The oral manifestations of OLP have been described in many large studies. […] Histologic confirmation of the diagnosis is thus required. […] The histologic features of OLP were first described by Dubreuill in 1906 and later revised by Shklar in 1972. […] The WHO developed a set of histopathological criteria for OLP in 1978, which was most recently modified in 2003. […] Definite diagnostic histologic findings include liquefactive degeneration of the basal cells, colloid bodies (Civatte, hyaline, cytoid), homogeneous infiltrate of lymphocytes in a dense, bandlike pattern along the epithelium-connective tissue interface in the superficial dermis, cytologically normal maturation of the epithelium, sawtooth rete ridges, and hyperkeratosis (orthokeratosis or parakeratosis). […] Several histologic criteria that are considered as exclusionary in diagnosing OLP include the absence of basal cell liquefaction degeneration, polyclonal inflammatory infiltrate, abnormal cytology suggestive of dysplasia, abnormal keratinization, flat rete ridges, and absence of colloid bodies.

• #45 Diagnostic Criteria of Oral Lichen Planus: A Narrative Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8212651/

  Significant changes have been made over years concerning the diagnosis of OLP. According to the WHO, there is a lack of clinical and histologic criteria for both OLP and OLL. […] The clinical (history and presentation), histopathologic, immunofluorescence, biomarkers, reflectance confocal microscopy, fluorescence spectroscopy, and/or therapeutic probation features detailed below support the diagnosis of OLP and OLL. […] Diagnosis of OLP is established by clinical examination with histopathologic confirmation. Direct immunofluorescence examination is used to rule out particular autoimmune diseases (e.g., pemphigus, pemphigoid). […] Histopathologic diagnosis confirms the clinical diagnosis of OLP. The correlation between clinical and histopathologic diagnosis is crucial for definitive diagnosis of OLP. OLP necessitates additional biopsy for direct immunofluorescence assessment and/or histopathologic evaluation, so continued clinical follow-up after the initial biopsy is essential. […] Oral lichenoid lesions must be distinguished from OLP by two factors. First, the association with the administration of a drug, contact with a metal or foodstuff, or presence of a systemic disease must be verified. Second, elimination of the offending agent leads to resolution of the OLL.

• #46 Clinico-Pathological Study to Evaluate Oral Lichen Planus for the Establishment of Clinical and Histopathological Diagnostic Criteria – Turkish Journal of Pathology

  https://turkjpath.org/text.php?id=1723

  Objective: Lichen planus and lichenoid lesions affecting the oral cavity show similar clinico-pathological features creating a diagnostic dilemma. Hence, the aim of the present study was to establish a clinical and histopathological correlation in the diagnosis of oral lichen planus, based on the modified WHO diagnostic criteria of oral lichen planus and oral lichenoid lesions proposed by Van der Meij and Van der Waal in 2003. […] The results of the present study revealed mild to moderate clinico-pathological correlation in the final diagnosis of oral lichen planus for the prospective and retrospective study groups respectively. […] The aim of the present study was therefore to establish a clinical and histopathological correlation in the diagnosis of OLP, based on the modified WHO diagnostic criteria of OLP and OLL.

• #47 Clinico-Pathological Study to Evaluate Oral Lichen Planus for the Establishment of Clinical and Histopathological Diagnostic Criteria – Turkish Journal of Pathology

  https://turkjpath.org/text.php?id=1723

  Objective: Lichen planus and lichenoid lesions affecting the oral cavity show similar clinico-pathological features creating a diagnostic dilemma. Hence, the aim of the present study was to establish a clinical and histopathological correlation in the diagnosis of oral lichen planus, based on the modified WHO diagnostic criteria of oral lichen planus and oral lichenoid lesions proposed by Van der Meij and Van der Waal in 2003. […] The results of the present study revealed mild to moderate clinico-pathological correlation in the final diagnosis of oral lichen planus for the prospective and retrospective study groups respectively. […] The aim of the present study was therefore to establish a clinical and histopathological correlation in the diagnosis of OLP, based on the modified WHO diagnostic criteria of OLP and OLL.

• #48 Oral Lichen Planus: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17875-oral-lichen-planus

  Oral lichen planus (OLP) is a condition that causes inflammation inside your mouth. […] A healthcare provider can diagnose oral lichen planus by examining your mouth. In many cases, providers take a tissue biopsy to confirm the diagnosis and rule out other diseases. […] Treatment for OLP focuses on reducing symptoms and preventing flare-ups. This means you may not need treatment if you dont have symptoms that are bothering you. […] Once youre diagnosed with oral lichen planus, youll need regular check-ups to keep tabs on your condition. This is the case even if youre going through a period with no symptoms. […] Oral lichen planus can be mistaken for a yeast infection in your mouth (thrush) and leukoplakia. Like OLP, both involve white patches or spots in your mouth. But their causes are different, and so are their treatments. A healthcare provider will do tests to find out which condition you have.

• #49 Oral lichen planus and lichenoid lesions – challenges and pitfalls for the general dental practitioner | British Dental Journal

  https://www.nature.com/articles/s41415-024-7063-y

  All patients with OLP/OLLs should be monitored by a dental practitioner. Changes to the typical pattern of disease should instigate a referral to secondary care for consideration of biopsy to assess for dysplasia or malignancy. […] Management of OLP is aimed at symptom control, thus minimising impact on daily activities and improving quality of life. […] OLLs may present atypically when compared to idiopathic OLP and histological diagnosis in secondary care is often required. […] Suspected lichenoid drug reactions should be referred to secondary care for diagnostic confirmation and liaison with the prescribing physician regarding drug substitution where appropriate. […] Close surveillance of OLP and OLLs is critical because of the potential for malignant transformation. […] The appearance of mucosal disease should be documented at every appointment, if possible, with supporting clinical photographs. […] Monitoring in secondary care is dependent on disease severity.

• #50

  https://www.singhealth.com.sg/patient-care/conditions-treatments/oral-lichen-planus

  Lichen planus is a chronic disorder which can affect the skin, genitalia and/or the oral tissues. […] In about 50% of the cases, only the mouth is involved. This condition is called oral lichen planus. […] Oral lichen planus itself is not a cancerous condition. However, it is important to have a biopsy done to confirm its diagnosis and to be periodically examined by the dental surgeon or physician. Additional biopsies may be necessary from time to time to check for any tissue changes as there is a 1% risk of cancer change. […] Symptom-free cases will not require any treatment but should be reviewed by the dental surgeon or physician every six months to one year. […] For symptomatic cases, much of the discomfort can often be reduced simply by avoiding triggering factors such as spicy food or certain toothpastes or mouthwashes, and maintaining good oral hygiene. Medications or dental fillings may need to be changed if these are suspected to be associated with the appearance of the disease. Change of medications would require approval from your physician.

• #51 Oral lichen planus and lichenoid lesions – challenges and pitfalls for the general dental practitioner | British Dental Journal

  https://www.nature.com/articles/s41415-024-7063-y

  It has been suggested that a diagnosis of OLP can be made in asymptomatic patients with typical reticular and bilateral buccal striations without the need for a biopsy. […] The role of histopathology in discerning OLP from OLLs can be very limited due to the mostly indistinguishable features. […] However, subtle histological differences that may be identified include deep perivascular lymphocytic infiltrate in oral lupus, and even in lichenoid reactions. […] A small proportion of OLP and OLLs demonstrate malignant transformation to oral squamous cell carcinoma (0.5-2.5% over five years). […] The malignant potential of OLP and OLLs has been long debated, but a recent consensus report by the WHO Collaborating Centre for Oral Cancer has listed both OLP and OLLs as potentially malignant disorders.

• #52 Manifestations of Oral Lichen Planus – Decisions in Dentistry

  https://decisionsindentistry.com/article/manifestations-of-oral-lichen-planus/

  Recognizing and managing the various clinical presentations of oral lichen planus are essential for effective diagnosis, treatment, and ongoing monitoring. […] Discuss the differential diagnosis for OLP and the importance of biopsy for accurate assessment. […] Though OLP has traditionally been considered benign, prompt biopsy of all unilateral or bilateral suspected OLP- lichenoid type lesions is advised. Without biopsy, OLP may mask an underlying leukoplakic or lichenoid dysplasia. […] The malignant potential of OLP-OSCC remains under debate. […] Because the OLP lesions may never resolve, even with treatment, they should be closely monitored after biopsy, especially erosive OLP forms, which have the highest OSCC transformation rate. […] It is essential to monitor and follow up on all OLP lesions at every appointment after a histopathologic diagnosis. A complete oral cancer examination is recommended along with oral photography and a periodontal probe measurement to document changes in size. […] Repeated biopsies may be required for OLP lesions with erosive tendencies, any noted clinical changes, history of OLP-OSCC, or additional risk factors. […] A thorough medication and medical history, interprofessional coordination, and biopsy are key to successful diagnosis and treatment.

• #53 Oral Lichen Planus: A Narrative Review Navigating Etiologies, Clinical Manifestations, Diagnostics, and Therapeutic Approaches

  https://www.mdpi.com/2077-0383/13/17/5280

  Diagnosis of OLP is challenging because of overlapping clinical and histopathological features. […] Investigations include biopsy (histopathological and immunofluorescence), in addition to other tests. […] A 4 mm punch biopsy should be adequate for both cutaneous and oral assessments. […] To establish a definitive diagnosis, the integration of both clinical observations and histopathological findings is essential. […] A diagnosis of OLP requires fulfillment of both clinical and histopathological criteria. […] The progression of OLP to OSCC is a focal point of research due to the implications of genetic and cellular changes in this progression. […] The picture regarding OLP transformation to OSCC is further complicated by the variability in reported risk. […] Regular cancer screenings, biopsies, and integrated healthcare approaches are essential for optimal therapy due to the low malignancy risk associated with OLP and the adverse consequences of long-term corticosteroid usage.

• #54 Manifestations of Oral Lichen Planus – Decisions in Dentistry

  https://decisionsindentistry.com/article/manifestations-of-oral-lichen-planus/

  Recognizing and managing the various clinical presentations of oral lichen planus are essential for effective diagnosis, treatment, and ongoing monitoring. […] Discuss the differential diagnosis for OLP and the importance of biopsy for accurate assessment. […] Though OLP has traditionally been considered benign, prompt biopsy of all unilateral or bilateral suspected OLP- lichenoid type lesions is advised. Without biopsy, OLP may mask an underlying leukoplakic or lichenoid dysplasia. […] The malignant potential of OLP-OSCC remains under debate. […] Because the OLP lesions may never resolve, even with treatment, they should be closely monitored after biopsy, especially erosive OLP forms, which have the highest OSCC transformation rate. […] It is essential to monitor and follow up on all OLP lesions at every appointment after a histopathologic diagnosis. A complete oral cancer examination is recommended along with oral photography and a periodontal probe measurement to document changes in size. […] Repeated biopsies may be required for OLP lesions with erosive tendencies, any noted clinical changes, history of OLP-OSCC, or additional risk factors. […] A thorough medication and medical history, interprofessional coordination, and biopsy are key to successful diagnosis and treatment.

• #55 Oral lichen planus and lichenoid lesions – challenges and pitfalls for the general dental practitioner | British Dental Journal

  https://www.nature.com/articles/s41415-024-7063-y

  All patients with OLP/OLLs should be monitored by a dental practitioner. Changes to the typical pattern of disease should instigate a referral to secondary care for consideration of biopsy to assess for dysplasia or malignancy. […] Management of OLP is aimed at symptom control, thus minimising impact on daily activities and improving quality of life. […] OLLs may present atypically when compared to idiopathic OLP and histological diagnosis in secondary care is often required. […] Suspected lichenoid drug reactions should be referred to secondary care for diagnostic confirmation and liaison with the prescribing physician regarding drug substitution where appropriate. […] Close surveillance of OLP and OLLs is critical because of the potential for malignant transformation. […] The appearance of mucosal disease should be documented at every appointment, if possible, with supporting clinical photographs. […] Monitoring in secondary care is dependent on disease severity.

• #56 Oral lichen planus – BAD Patient Hub

  https://www.skinhealthinfo.org.uk/condition/oral-lichen-planus/

  Oral lichen planus is an inflammatory condition that affects the mouth. […] The dentist or doctor may be able to make a diagnosis of oral lichen planus based solely on the appearance of the inside of the mouth. However, it is sometimes necessary to take a small sample (biopsy) from an affected area for examination under a microscope. […] In most cases oral lichen planus cannot be cured, but it may go away on its own. […] In most people, oral lichen planus is not serious. However, an important, although uncommon, feature of oral lichen planus is a tendency to cancerous change, with about a 1% risk over a period of 10 years.

• #57 Diagnosis and management of oral lichen planus – Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8859620/

  Oral lichen planus (OLP) is an auto immune, common, chronic T-cell-mediated inflammatory disorder of the skin and mucous membranes that occurs in various clinical forms that often poses a diagnostic and therapeutic challenge due to its refractory course and relapsing nature. […] The diagnosis of an OLP may be made on visual examination without any biopsy when the lesion presents with the characteristic Wickham’s striae. […] A complete history and clinical assessment by various specialists such as dermatologist, ophthalmic surgeon, general physician and gastroenterologist may be required to investigate the involvement other than oral cavity. […] The investigations include (1) cytology, (2) hematology and (3) biopsy (histopathological and immunofluorescence). […] The histopathology is the gold standard method used in diagnosing OLP.

• #58 Oral Lichen Planus Treatment – Harley Street Maxillofacial Clinic

  https://harleystreetmaxillofacialclinic.com/oral-conditions/lichen-planus-treatment/

  Oral lichen planus is an immune disorder where white blood cells involved in inflammation become activated. […] At our London clinic, a maxillofacial consultant with expertise in lichen planus will assess your condition. This will include a thorough physical examination, a review of your medical history, and a discussion of your symptoms and how they affect you. […] A specialist will be able to identify subtle differences in your symptoms, which can provide valuable clues. They may recommend blood tests, allergy tests, cellular tests for secondary infections, or, if necessary, a biopsy. […] They will work to rule out other conditions, such as lupus, and confirm immune system proteins associated with oral lichen planus, helping to pinpoint a specific cause.

• #59 When to See a Dermatologist for Lichen Planus

  https://ostrowonline.usc.edu/when-to-see-a-dermatologist-for-lichen-planus/

  Oral lichen planus (OLP) is an immune-mediated disease with an unknown etiology. […] A biopsy will be performed for definitive diagnosis and to rule out other conditions with similar clinical presentation. […] If you suspect the presence of skin lesions in oral lichen planus are experiencing persistent skin changes, discomfort, or other associated symptoms, or the patient is not responding to the conventional treatment it is crucial to consult with a dermatologist. […] Dermatologists are specialized healthcare professionals equipped to accurately diagnose and effectively treat various skin conditions, including lichen planus. […] Timely intervention and expert guidance can help manage symptoms, alleviate discomfort, and improve overall quality of life.

• #60 Manifestations of Oral Lichen Planus – Decisions in Dentistry

  https://decisionsindentistry.com/article/manifestations-of-oral-lichen-planus/

  Recognizing and managing the various clinical presentations of oral lichen planus are essential for effective diagnosis, treatment, and ongoing monitoring. […] Discuss the differential diagnosis for OLP and the importance of biopsy for accurate assessment. […] Though OLP has traditionally been considered benign, prompt biopsy of all unilateral or bilateral suspected OLP- lichenoid type lesions is advised. Without biopsy, OLP may mask an underlying leukoplakic or lichenoid dysplasia. […] The malignant potential of OLP-OSCC remains under debate. […] Because the OLP lesions may never resolve, even with treatment, they should be closely monitored after biopsy, especially erosive OLP forms, which have the highest OSCC transformation rate. […] It is essential to monitor and follow up on all OLP lesions at every appointment after a histopathologic diagnosis. A complete oral cancer examination is recommended along with oral photography and a periodontal probe measurement to document changes in size. […] Repeated biopsies may be required for OLP lesions with erosive tendencies, any noted clinical changes, history of OLP-OSCC, or additional risk factors. […] A thorough medication and medical history, interprofessional coordination, and biopsy are key to successful diagnosis and treatment.

• #61 Diagnostic Criteria of Oral Lichen Planus: A Narrative Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8212651/

  Oral lichen planus (OLP) is a disease with unclear etiology or pathogenesis, categorized by the World Health Organization as oral lichenoid lesions (OLL; interface mucositis or lichenoid mucositis) into a group of potentially malignant disorders. The diagnosis of OLP is challenging because the clinical and histopathologic features are frequently seen in OLP, OLL and/or other mucosal diseases with lichenoid characteristics. […] A reliable diagnosis of OLP and OLL has proved challenging due to both dynamic nature of the lesions and similar clinical and histologic appearances in various conditions. Thorough medical history of the patient along with complete mucocutaneous examination before particular diagnostic tests, and due knowledge of the clinical and pathological variations of OLP and OLL are essential to make an accurate diagnosis.

• #62 Clinico-Pathological Study to Evaluate Oral Lichen Planus for the Establishment of Clinical and Histopathological Diagnostic Criteria – Turkish Journal of Pathology

  https://turkjpath.org/text.php?id=1723

  The inter-observer agreement of clinical and histopathological diagnosis of OLP among three observers was analyzed by using Kappa statistics and summarized in Table III. […] The Kappa statistics revealed good to very good agreement for both clinical and histopathological findings between the observers and agreement was higher in clinical findings than the histopathological findings. […] In group 1, inter-observer agreement in the final diagnosis appears to be good to very good but correlation of the clinico-pathological diagnosis resulted in mild sensitivity of 38%. […] This assessment indicates that histopathological confirmation of clinical cases is mandatory for the final diagnosis of true OLP. […] In conclusion, the results of the present study show a lack of clinico-pathological correlation in the diagnostic assessment of OLP. To confirm the clinical diagnosis of OLP, histopathological assessment has to be performed and the final diagnosis has to be achieved only after the correlation of clinical and histopathological diagnosis.

• #63

  https://rsdjournal.org/index.php/rsd/article/view/42698

  Oral lichen planus is an autoimmune disease, clinically visible as whitish streaks called Wickham’s striae and which, although it has no defined etiology, is associated with some possible causal factors, such as: emotional conditions, use of some dental materials, medications, harmful habits and as a result of trauma. […] Its diagnosis is formed by a set of actions. […] It is concluded from the analysis of the articles that the diagnostic method is a consensus among the authors, through the correlation of clinical and histological characteristics, patient history and use of medications and, when necessary, a biopsy should be performed so that immunofluorescence can be performed direct to distinguish diseases that have the same characteristics and tend to cause confusion in the diagnostic process.

• #64 Oral lichen planus | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/90/12/717

  A 36-year-old male presented with lesions over the lips and the left buccal mucosa for the past 6 months. […] Clinical examination revealed a nonindurated, well-defined, violaceous plaque with a white, lacy appearance on the lower lip and the left buccal mucosa. […] The differential diagnoses included lichen planus, oral candidiasis, oral lichenoid reaction, and leukoplakia. […] Based on the classical nonindurated reticular plaques with the pathognomonic Wickham striae, absence of a preceding drug-intake history, negative potassium hydroxide study, and histopathologic findings, a diagnosis of oral reticular lichen planus was made. […] Oral lichen planus involving the buccal mucosa, gingiva, and tongue affects 1% to 2% of the worlds population. […] The reticular type is often asymptomatic, and the presence of interlacing white streaks suggestive of Wickham striae is pathognomonic.

• #65 Oral lichen planus – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/oral-lichen-planus/diagnosis-treatment/drc-20350874

  Your healthcare professional may make a diagnosis of oral lichen planus based on: […] Your healthcare professional also may request lab tests, such as: […] A biopsy. In this test, a small tissue sample is taken from one or more spots in your mouth. This sample is studied under a microscope to see if oral lichen planus is present. Other, more specialized microscopic tests may be needed to find immune system proteins commonly related to oral lichen planus. […] Blood tests. These tests may be done to find conditions such as hepatitis C, which may rarely be related to oral lichen planus, and lupus, which may look like oral lichen planus. […] Your healthcare professional will likely ask more questions based on your responses, symptoms and needs. Prepare for questions to make the most of your appointment time.

• #66 Oral Lichen Planus: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17875-oral-lichen-planus

  Oral lichen planus (OLP) is a condition that causes inflammation inside your mouth. […] A healthcare provider can diagnose oral lichen planus by examining your mouth. In many cases, providers take a tissue biopsy to confirm the diagnosis and rule out other diseases. […] Treatment for OLP focuses on reducing symptoms and preventing flare-ups. This means you may not need treatment if you dont have symptoms that are bothering you. […] Once youre diagnosed with oral lichen planus, youll need regular check-ups to keep tabs on your condition. This is the case even if youre going through a period with no symptoms. […] Oral lichen planus can be mistaken for a yeast infection in your mouth (thrush) and leukoplakia. Like OLP, both involve white patches or spots in your mouth. But their causes are different, and so are their treatments. A healthcare provider will do tests to find out which condition you have.

• #67 Oral lichenplanus: Etiology, pathogenesis, diagnosis, and management

  https://www.wjgnet.com/2218-6263/full/v4/i1/12.htm

  Absence of basal cell liquefaction, atypical cytomorphology, heterogeneous population of infiltrate, nucleus enlargement, blunted rete ridges, increased mitotic figures, absence of civatte bodies, abnormal keratinization will help to rule out the definitive diagnosis of OLP. […] Direct Immunofluorescent examination of tissue in case of OLP demonstrates deposition of fibrinogen along the basement membrane zone. […] The sensitivity of direct immunofluorescence is positive for 65.8% of the patients with OLP. […] Direct oral microscopy technique is noninvasive which helps in clinical examination of oral cavity. […] The inflammatory component of OLP is treated with various above mentioned methods and additional approaches are required for assessing and treating dysplastic component in these cases. […] Therefore early diagnosis and treatment is mandatory with periodical follow up of the patients.

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