How can I get relief from the oral lichen planus?

 

Oral lichen planus is a chronic inflammatory condition of unknown cause. Lichen planus of the mouth is typically painful and consisting of white and maybe ulcerated lesion. The condition itself does not have a cure but is manageable. Despite having a “lichen” name on it which translates as “fungal-like”, lichen planus is not due to fungal infection.

Oral lichen planus may be confused with other similar presentation of the mouth lesion such as leukoplakia (early lesion of mouth cancer), oral candidiasis, mouth cancer and oral allergic reaction. Treating oral lichen planus needs an expert evaluation as to provide appropriate treatment according to the lesion and not mistakenly missing out important and dangerous lesion like mouth cancer. Here are pharmacologic and non-pharmacologic ways to get relief from oral lichen planus.

1. Pharmacology (Medications)

1. Topical Corticosteroid (steroids) application

Corticosteroids or steroids for short works by inhibiting the inflammatory cells and markers either on-site (topical) or systemically. Since oral lichen planus is an inflammatory condition, using a targetted treatment aiming at the white cells and inflammatory markers can significantly relieve the lichen planus symptoms.

The steroid is not given by pill or systemically to avoid long-term adverse reactions like osteoporosis (brittle bones), weight gain, depression and fatigue. However, a topical administration of steroid medication itself is not without its complication. Common side effects that may occur to the patient is the infection of the mouth for example by the candida fungal causing oral candidiasis.

2. Topical Immune-Modulator

This is a group of medication that have a different mechanism of action to steroids as well as side effects. This group of drugs are the calcineurin inhibitor and examples of drugs under this category are pimecrolimus or tacrolimus. This is the second line of treatment after corticosteroids as the use of calcineurin inhibitor is expensive and requires further specialist evaluation. The efficacy of these medications is very similar to steroids.

3. Systemic Agent (for severe and refractory disease)

For patients who experienced with difficult topical lichen planus management, a more advanced treatment through systemic drugs may be used. This includes systemic steroids and immune-modulatory drug such as methotrexate. All these are the last option as systemic drugs will expose to many other unwanted adverse effects and regular patient monitoring also is required.

1. B) Non-Pharmacology Intervention

Non-pharmacology methods involve ways to care for the conditions without any use of topical or pill medication. Oral care is important for patients with lichen planus to reduce the severity and symptoms felt by them. A few suggested non-pharmacologic relief includes:

1. Maintaining good oral hygiene by brushing and flossing twice daily. Patients also are advised to have dental cleaning by the dentist every 3-4 months.
2. Avoid habits that may cause trauma on the lips or the inner mouth like chewing food with wide-open mouth, chewing a piece of gum or using a toothpick (use a string of floss instead!).
3. Stop smoking for those who are still smoking. The chemicals in the cigarette smoke can delay healing and further cause inflammation of the oral lichen planus to worsen.
4. Do not take spicy, too hot, too salty, acidic, rough and sharp foods. Avoid alcohol intake as well. This is because all of these types of foods are irritant to the mouth mucosa and may cause ulcerating lichen planus.

In summary, oral lichen planus needs treatment by an experienced doctor. Find doctors in Malaysia with such qualifications if you or anyone you know are experiencing this issue.