Lichen planus, lichenoid drug reactions, and lichenoid mucositis

OLP and lichenoid reaction are a relatively common oral mucosal disease process encountered in clinical practice. This mucocutaneous disease can manifest as desquamative gingivitis, asymptomatic Wickham's striae or plaques, or severe, painful erosions or ulcerations anywhere in the oral cavity. Although the exact agent initiating LP is unknown, current research points to a number of complex immunologic events and cells that are responsible for the inflammatory destruction and chronicity of these lesions. Currently, the mainstay of treatment remains topical corticosteroids, but newer therapies such a tacrolimus are available for recalcitrant lesions. In cases of lichenoid mucositis or reactions, treatment should always be directed toward identifying and removing the presumed causative agent. Given the apparent risk of squamous cell carcinoma in these patients, frequent follow-up and repeat biopsy when indicated are vital.