Oral lichen planus is a chronic, T-cell-mediated inflammatory condition that targets the mucous membranes lining the oral cavity, most frequently the buccal mucosa, tongue, and gingiva. It is an immune-mediated disorder in which the body’s own lymphocytes attack basal epithelial cells, producing a spectrum of lesions that range from asymptomatic white lace-like patterns to severely painful erosions.

Clinical Presentations

Oral lichen planus manifests in several distinct forms, each with different appearances and levels of discomfort:

• Reticular: The most common form, defined by interlacing white lines called Wickham’s striae on the buccal mucosa.
• Erosive/Ulcerative: Painful red ulcerations surrounded by white striae; the most symptomatic and clinically significant variant.
• Atrophic: Diffuse erythematous patches frequently involving the gingiva, often resembling desquamative gingivitis.
• Plaque-type: Homogeneous white lesions that can closely resemble oral leukoplakia, making biopsy essential for differentiation.
• Bullous: A rare blistering form that produces fluid-filled vesicles which rupture and leave painful erosions.

Clinical Significance

Beyond the discomfort these lesions cause, oral lichen planus carries a low but meaningful risk of malignant transformation to oral squamous cell carcinoma, estimated between 0.5% and 2% over time. This potential makes periodic clinical monitoring — including biopsy of any changing or suspicious lesion — an essential component of long-term management. Gingival involvement can impair effective oral hygiene, increasing susceptibility to periodontal disease, while erosive lesions create an environment prone to secondary candidal superinfection.

Diagnosis and Management

Definitive diagnosis requires incisional biopsy with direct immunofluorescence, which reveals a characteristic band-like lymphocytic infiltrate at the epithelial-connective tissue junction. Management is primarily symptomatic and individualized:

• Topical corticosteroids serve as first-line therapy for erosive and atrophic lesions
• Systemic immunosuppressants are reserved for refractory or widespread disease
• Replacement of implicated dental materials — such as amalgam restorations associated with localized lichenoid reactions — may reduce symptom burden
• Antifungal agents are indicated when candidal superinfection is present

Consistent follow-up with thorough mucosal examination remains the most effective strategy for detecting dysplastic change early and preserving long-term oral health.