Oral lichens planus-Oral lichen planus: An update on pathogenesis and treatment

Oral lichen planus OLP is a chronic inflammatory disease that affects the mucus membrane of the oral cavity. A wide spectrum of treatment modalities is available, from topical corticosteroids to laser ablation of the lesion. In this review, we discuss the various concepts in the pathogenesis and current treatment modalities of OLP. Lichen planus is a chronic inflammatory disease that affects the skin and the mucus membrane. Intraorally, the buccal mucosa, tongue and the gingiva are commonly involved although other sites may be rarely affected.

Oral lichens planus

Oral lichens planus

Oral lichens planus

Oral lichens planus

Oral lichens planus causes oral lichen planus. Oral lichens planus pain refers to pain in the muscles, bones, ligaments, tendons, and nerves. In the meantime, there are things you can try to help calm or quiet your anxiety…. Efalizumab, a monoclonal antibody to CD11a, binds to this adhesion molecule and causes improvement in OLP by decreased activation and trafficking of T lymphocytes. They may check other areas on your Oral lichens planus to look for other areas affected by lichen planus. J Cutan Pathol. Abstract Oral lichen planus OLP is a chronic inflammatory disease that affects the mucus membrane of the oral cavity. Oral erosive lichen planus treated with efalizumab. In pigmented villonodular synovitis PVNSthe synovium swells. Nudist hunting your take on meditation is that it's boring or too "new age," then read this.

Pulic sex fantasy. INTRODUCTION

The histologic findings of these disorders are also similar. A wide spectrum of Oral lichens planus modalities is available, from topical corticosteroids to laser ablation of the lesion. Initially, the characteristic surface markings or striae was described by Weyl in Lichen planus is an inflammatory disorder that appears as purplish, flat-topped bumps when it affects the skin. Corticosteroids have been the mainstay of management of OLP; yet, other modalities like calcineurin inhibitors, retinoids, dapsone, hydroxychloroquine, Oral lichens planus mofetil and enoxaparin have contributed significantly toward treatment of the disease. Oral Diseases. This is a rare variant of lichen planus, and also known as "Vesiculobullous lichen planus. Clinics in Dermatology. This morphology is characterized by hyperpigmented, dark-brown macules in sun-exposed areas and flexural folds. CO 2 laser evaporation of oral lichen planus. Glucosephosphate dehydrogenase G6PD deficiency can increase the risk of hemolytic anemia or methemoglobinemia in patients receiving dapsone.

Lichen planus is a chronic, or long-term, disease affecting the skin and mucous membranes, the thin layers of tissue that line body cavities and secrete mucus.

  • January
  • Lichen planus is an itchy skin rash that is caused by an immune response.

Lichen planus is a chronic, or long-term, disease affecting the skin and mucous membranes, the thin layers of tissue that line body cavities and secrete mucus. When lichen planus appears in the mouth, it is called oral lichen planus. The skin and oral types of lichen planus together affect an estimated two percent of the population. Anyone can develop oral lichen planus. Women are twice as likely as men to develop the condition. The exact cause of oral lichen planus is unknown.

Research suggests the condition is related to your genetic makeup and immune system. Some people develop oral lichen planus after taking certain medications, such as beta-blockers and nonsteroidal anti-inflammatory drugs NSAIDs.

Diseases such as hepatitis B and primary biliary cirrhosis may also cause oral lichen planus. These patches and threads are raised slightly. This type of lichen planus is usually not painful. In some cases, oral lichen planus erosive type appears as bright red gum tissue. In severe cases, ulcers develop on the gums of mucosal tissues inside the mouth, or on the tongue. Eating and drinking spicy, hot or acidic foods or beverages can be painful for people with oral lichen planus.

Skin lesions are common among people with oral lichen planus. Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Oral Lichen Planus Lichen planus is a long-term condition that affects the skin and mucus membranes. When it affects the mouth it is called oral lichen planus, and appears as white patches or web-like threads inside the cheeks.

What is oral lichen planus? How common is oral lichen planus? Who is likely to have oral lichen planus? No, oral lichen planus does not spread from person to person. What causes oral lichen planus? What are the symptoms of oral lichen planus?

How is oral lichen planus treated? Corticosteroids have been the mainstay of management of OLP; yet, other modalities like calcineurin inhibitors, retinoids, dapsone, hydroxychloroquine, mycophenolate mofetil and enoxaparin have contributed significantly toward treatment of the disease. A punch biopsy of sufficient depth to the mid dermis is usually significant. Mycophenolates are quite expensive and effective with long-term usage. A seasoned traveler, Lou Appignani relishes exploration and discovery. The immunosuppressive action of tacrolimus is similar to that of cyclosporine, although it has a greater capacity to penetrate the mucosa. Herbal teas are popular beverage choices when it comes time to relax and unwind.

Oral lichens planus

Oral lichens planus

Oral lichens planus

Oral lichens planus

Oral lichens planus

Oral lichens planus. What is oral lichen planus?

Oral lichen planus can increase the risk of secondary yeast or fungal infections. Open sores also have a higher risk of bacterial infections. People who have oral lichen planus should have regular checkups with their dentist, as they have a higher risk for developing mouth cancer in the affected areas.

Treatment will focus on resolving symptoms and minimizing lesions as much as possible. Oral lichen planus is a chronic condition. Because of this, maintaining regular appointments with your dentist or healthcare provider can help you manage your symptoms and adjust your treatment plan as needed.

They will also watch for any potential signs of mouth cancer. Identifying your triggers can take some time and self-reflection. In the meantime, there are things you can try to help calm or quiet your anxiety…. If your take on meditation is that it's boring or too "new age," then read this. One man shares how - and why - he learned to meditate even though he…. Cholesterol is a fatty substance that's needed to build cells. Tenosynovial giant cell tumors cause pain, swelling, and stiffness in the joints.

If left untreated, tenosynovial giant cell tumors can cause…. Musculoskeletal pain refers to pain in the muscles, bones, ligaments, tendons, and nerves. You can feel this pain in just one area of the body, such…. Tenosynovial giant cell tumor TGCT is a group of rare tumors that form in the joints. It's not cancer. In pigmented villonodular synovitis PVNS , the synovium thickens, forming a growth called a tumor. PVNS isn't cancer, but it can cause complications…. In pigmented villonodular synovitis PVNS , the synovium swells.

PVNS isn't cancer, but it can cause complications if left untreated. Here's what you…. Herbal teas are popular beverage choices when it comes time to relax and unwind. Here are the 6 best teas that help you sleep. Tonalin contains conjugated linoleic acid CLA. Advocates say it can burn fat quickly, while preserving the strength and shape of your muscles. These lesions have to be differentiated from lichen planus because CUS does not respond to corticosteroid therapy and has to be treated using antimalarial drugs.

Corticosteroids have been the mainstay of management of OLP; yet, other modalities like calcineurin inhibitors, retinoids, dapsone, hydroxychloroquine, mycophenolate mofetil and enoxaparin have contributed significantly toward treatment of the disease. They act by reducing the lymphocytic exudate and stabilizing the lysosomal membrane. Although trials were done using topical steroids along with adhesive base, no study shows their superiority when compared to steroids without the base carboxymethyl cellulose.

This has shown excellent bioadhesive properties, due to its high molecular weight above , and the flexibility of the polymeric chain.

Long-term use of topical steroid can lead to the development of secondary candidiasis which necessitates antifungal therapy. Systemic corticosteroids are reserved for recalcitrant erosive or erythematous LP where topical approaches have failed. Systemic prednisolone is the drug of choice, but should be used at the lowest possible dosage for the shortest duration 40—80 mg for 5—7 days. Calcineurin is a protein phosphatase which is involved in the activation of transcription of IL-2, which stimulates the growth and differentiation of T-cell response.

These drugs are called calcineurin inhibitors. Cyclosporine, a calcineurin inhibitor, is an immunosuppressant used widely in post-allogenic organ transplant to reduce the activity of patient's immune system. This selectively suppresses T-cell activity, the main reason for transplant rejection, and hence enhances the uptake of the foreign organ. Cyclosporine binds to the cytosolic protein cyclophilin of immunocompetent lymphocytes, especially T-lymphocytes.

This complex of cylosporine and cyclophilin inhibits calcineurin, which under normal circumstances induces the transcription of IL They also inhibit lymphokine production and IL release, leading to a reduced function of effector T-cells.

Cyclosporine is used as a mouth rinse or topically with adhesive bases in OLP. However, the solution is prohibitively expensive and should be reserved for highly recalcitrant cases of OLP. Systemic absorption is very low. Tacrolimus, also a calcineurin inhibitor, is a steroid-free topical immunosuppressive agent approved for the treatment of atopic dermatitis.

It is 10— times as potent as cyclosporine and has greater percutaneous absorption than cyclosporine. It has been successfully used in recalcitrant OLP cases. This substance is produced by Streptomyces tsukubaensis and belongs to the macrolide family. The immunosuppressive action of tacrolimus is similar to that of cyclosporine, although it has a greater capacity to penetrate the mucosa.

It inhibits the first phase of T-cell activation, inhibiting the phosphatase activity of calcineurin. Burning sensation is the commonest side effect observed; relapses of OLP after cessation have also been observed.

Pimecrolimus inhibits T-cell activation by inhibiting the synthesis and release of cytokines from T cells. Pimecrolimus also prevents the release of inflammatory cytokines and mediators from mast cells.

Pimecrolimus has significant anti-inflammatory activity and immunomodulatory capabilities with low systemic immunosuppressive potential. Topical retinoids such as tretinoin, isotretinoin and fenretinide, with their immunomodulating properties, have been reported to be effective in OLP. Reversal of white striae can be achieved with topical retinoids, although effects may only be temporary. Systemic retinoids have been used in cases of severe lichen planus with variable degree of success. The positive effects of retinoids should be weighed against their rather significant side effects like cheilitis, elevation of serum liver enzymes and triglyceride levels and teratogenicity.

As an antibacterial agent, dapsone inhibits bacterial synthesis of dihydrofolic acid and hence is used in the treatment of leprosy. When used for the treatment of skin diseases, it probably acts as an anti-inflammatory agent by inhibiting the release of chemotactic factors for mast cells. Glucosephosphate dehydrogenase G6PD deficiency can increase the risk of hemolytic anemia or methemoglobinemia in patients receiving dapsone. Screening for G6PD deficiency is required before prescribing dapsone.

Hypersensitivity reaction to dapsone called Dapsone reaction is frequent in patients receiving multiple drug therapy. The symptoms of rash, fever and jaundice generally occur within the first 6 weeks of therapy and can be ameliorated by corticosteroid therapy. Originally used to treat psoriasis, mycophenolic acid now reformulated as mycophenolate mofetil has been reintroduced in dermatological medicine. Being a very well-tolerated immunosuppressive drug used in organ transplant, it has been successfully used to treat severe cases of OLP.

Mycophenolates are quite expensive and effective with long-term usage. Low-dose heparin devoid of anticoagulant properties inhibits T lymphocyte heparanase activity which is crucial in T-cell migration to target tissues. This promises to be a simple, effective and safe treatment for OLP when injected subcutaneously as it has no side effects. It is a recombinant humanized monoclonal antibody which is used as an immunosuppressant in the treatment of psoriasis.

Efalizumab, a monoclonal antibody to CD11a, binds to this adhesion molecule and causes improvement in OLP by decreased activation and trafficking of T lymphocytes.

It is administered once a week as a subcutaneous injection. It is currently an approved drug for the treatment of plaque psoriasis. This non-pharmacologic approach uses photochemotherapy with 8-methoxypsoralen and long wave ultraviolet light PUVA. Psoralens are compounds found in many plants, which make the skin temporarily sensitive to UV radiation.

Methoxypsoralen is given orally, followed by administration of 2 hours of UV radiation intraorally in the affected sites.

It has been successfully used in the treatment of severe cases of OLP. Also, dosimetry can be difficult within the complicated geometry of the mouth, because PUVA is usually administered on skin over large, open surfaces. Photodynamic therapy PDT is a technique that uses a photosensitizing compound like methylene blue, activated at a specific wavelength of laser light, to destroy the targeted cell via strong oxidizers, which cause cellular damage, membrane lysis, and protein inactivation.

PDT has been used with relative success in the field of oncology, notably in head and neck tumors. PDT is found to have immunomodulatory effects and may induce apoptosis in the hyperproliferating inflammatory cells which are present in psoriasis and lichen planus. This may reverse the hyperproliferation and inflammation of lichen planus. In patients who are suffering from painful erosive OLP and are unresponsive to even topical superpotent corticosteroids, surgical management using cryosurgery and different types of laser have also been tried.

A nm Diode laser,[ 30 ] CO 2 laser evaporation,[ 31 ] biostimulation with a pulsed diode laser using nm pulsed infrared rays[ 32 ] and low-dose excimer nm laser with UV-B rays have been tried.

A deeper penetrating beam like the diode laser destroys the underlying connective tissue with the inflammatory component along the epithelium. The few studies documented show a lot of promise, but their effectiveness is yet to be proven. No therapy for OLP is completely curative; the goal of treatment for symptomatic patients is palliation.

The following [ Figure 2 ] simple systematic protocol will aid in effective treatment. Relief can be achieved in a majority of cases through topical application of corticosteroids, with or without the combination of other immunomodulators. Very rarely does the condition necessitate systemic therapy. Laser therapy and other recent modalities are tried as the final remedy.

It is imperative that the lesion is identified precisely and proper treatment be administered at the earliest. A proper understanding of the pathogenesis of the disease becomes important for providing the right treatment. Source of Support: Nil. Conflict of Interest: None declared. National Center for Biotechnology Information , U. J Oral Maxillofac Pathol.

Author information Copyright and License information Disclaimer. Address for correspondence: Dr. E-mail: moc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.

This article has been cited by other articles in PMC. Abstract Oral lichen planus OLP is a chronic inflammatory disease that affects the mucus membrane of the oral cavity. Keywords: Apoptosis, autoimmune, basal keratinocytes, corticosteroids, oral lichen planus. Cyclosporine Cyclosporine, a calcineurin inhibitor, is an immunosuppressant used widely in post-allogenic organ transplant to reduce the activity of patient's immune system.

Tacrolimus Tacrolimus, also a calcineurin inhibitor, is a steroid-free topical immunosuppressive agent approved for the treatment of atopic dermatitis. Pimecrolimus Pimecrolimus inhibits T-cell activation by inhibiting the synthesis and release of cytokines from T cells.

Retinoids Topical retinoids such as tretinoin, isotretinoin and fenretinide, with their immunomodulating properties, have been reported to be effective in OLP.

Dapsone As an antibacterial agent, dapsone inhibits bacterial synthesis of dihydrofolic acid and hence is used in the treatment of leprosy. Mycophenolates Originally used to treat psoriasis, mycophenolic acid now reformulated as mycophenolate mofetil has been reintroduced in dermatological medicine.

Low-dose, low molecular weight heparin enoxaparin Low-dose heparin devoid of anticoagulant properties inhibits T lymphocyte heparanase activity which is crucial in T-cell migration to target tissues. Efalizumab It is a recombinant humanized monoclonal antibody which is used as an immunosuppressant in the treatment of psoriasis. Open in a separate window. Figure 1.

Proposed sites of action based on property of drugs in oral lichen planus. Photodynamic therapy Photodynamic therapy PDT is a technique that uses a photosensitizing compound like methylene blue, activated at a specific wavelength of laser light, to destroy the targeted cell via strong oxidizers, which cause cellular damage, membrane lysis, and protein inactivation.

Laser therapy In patients who are suffering from painful erosive OLP and are unresponsive to even topical superpotent corticosteroids, surgical management using cryosurgery and different types of laser have also been tried. Figure 2. The pathogenesis of oral lichen planus. Crit Rev Oral Biol Med.

Oral lichen planus OLP is a chronic inflammatory disease that affects the mucus membrane of the oral cavity. A wide spectrum of treatment modalities is available, from topical corticosteroids to laser ablation of the lesion. In this review, we discuss the various concepts in the pathogenesis and current treatment modalities of OLP. Lichen planus is a chronic inflammatory disease that affects the skin and the mucus membrane.

Intraorally, the buccal mucosa, tongue and the gingiva are commonly involved although other sites may be rarely affected. The skin lesions present as violaceous flat-topped papules in ankles, wrist, and genitalia, but characteristically the facial skin is spared. The etiology and pathogenesis of OLP has been the focus of much research, and several antigen-specific and nonspecific inflammatory mechanisms have been put forward to explain the pathogenesis.

In this review, we discuss the recent concepts in the pathogenesis and current treatment modalities of OLP. Attraction of the lymphocytes to the epithelium—connective tissue interface has also been proposed to be due to cytokine-mediated upregulation of adhesion molecules on endothelial cells and concomitant expression of receptor molecules by circulating lymphocytes.

This supports the above-explained hypothesis that the cytokine-mediated lymphocyte homing mechanism plays an important role in the pathogenesis of lichen planus. These are derived from the resident macrophages, Langerhans cells, lymphocytes and the overlying keratinocytes themselves, thus setting up a vicious cycle.

The normal integrity of the basement membrane is maintained by a living basal keratinocyte due to its secretion of collagen 4 and laminin 5 into the epithelial basement membrane zone. In turn, keratinocytes require a basement membrane derived cell survival signal to prevent the onset of its apoptosis. Again, a non-intact basement membrane cannot send a cell survival signal. This sets in a vicious cycle which relates to the chronic nature of the disease.

The matrix metalloproteinases MMP are principally involved in tissue matrix protein degradation. MMP- 9, which cleaves collagen 4, along with its activators is upregulated in OLP lesional T cells, resulting in increased basement membrane disruption.

This again sets in a vicious cycle which relates to the chronic nature of the disease. However, countries with highest prevalence of HCV report negative or nonsignificant associations suggesting that the LP—HCV association cannot be explained on the basis of high prevalence in population alone.

The characteristic band like lymphocytic infiltrate might thus be directed toward HCV infected cells. The putative pathogenetic link between OLP and HCV still remains controversial and needs a lot of prospective and interventional studies for a better understanding.

The diagnosis of reticular lichen planus can often be made based on the clinical findings alone. Interlacing white striae appearing bilaterally on the posterior buccal mucosa is often pathognomonic.

Difficulties arise often when there is superimposed candidal infection which masquerades the classic reticular pattern and in eliciting the erosive and erythematous forms of OLP. Lichenoid drug reactions are usually unilateral in distribution, accompanied by a history of new drug intake. A positive patch test, a strong clinical correlation of proximity of a restoration and biopsy suggestive of diffuse lymphocytic infiltrate rather than a subepithelial band favor a diagnosis of oral lichenoid reactions.

Biopsy of LE shows a characteristic perivascular infiltrate. Erosive or atrophic types that usually affect the gingiva should be differentiated from pemphigoid, as both may have a desquamative clinical appearance. Both pemphigus and pemphigoid occur as solitary erythematous lesions and are not associated with any white striae. This can aid in clinical differential diagnosis as erosive and atrophic forms of OLP usually show concomitant reticular form.

Peeling of the epithelium from the epithelium—connective tissue junction on slight lateral pressure in nonaffected area Nikolsky's sign differentiates it from erosive and erythematous forms of lichen planus. A biopsy from the perilesional tissue can diagnose pemphigus or pemphigoid, which show intraepithelial or subepithelial split histologically.

Chronic ulcerative stomatitis CUS is an immune-mediated disorder affecting the oral mucosa which clinically and histopathologically resembles lichen planus. Diagnosis of CUS is based on direct immunofluorescence studies where autoantibodies are directed against p63 in the basal and parabasal layers of the epithelium.

These lesions have to be differentiated from lichen planus because CUS does not respond to corticosteroid therapy and has to be treated using antimalarial drugs. Corticosteroids have been the mainstay of management of OLP; yet, other modalities like calcineurin inhibitors, retinoids, dapsone, hydroxychloroquine, mycophenolate mofetil and enoxaparin have contributed significantly toward treatment of the disease. They act by reducing the lymphocytic exudate and stabilizing the lysosomal membrane.

Although trials were done using topical steroids along with adhesive base, no study shows their superiority when compared to steroids without the base carboxymethyl cellulose.

This has shown excellent bioadhesive properties, due to its high molecular weight above , and the flexibility of the polymeric chain. Long-term use of topical steroid can lead to the development of secondary candidiasis which necessitates antifungal therapy. Systemic corticosteroids are reserved for recalcitrant erosive or erythematous LP where topical approaches have failed. Systemic prednisolone is the drug of choice, but should be used at the lowest possible dosage for the shortest duration 40—80 mg for 5—7 days.

Calcineurin is a protein phosphatase which is involved in the activation of transcription of IL-2, which stimulates the growth and differentiation of T-cell response. These drugs are called calcineurin inhibitors. Cyclosporine, a calcineurin inhibitor, is an immunosuppressant used widely in post-allogenic organ transplant to reduce the activity of patient's immune system.

This selectively suppresses T-cell activity, the main reason for transplant rejection, and hence enhances the uptake of the foreign organ. Cyclosporine binds to the cytosolic protein cyclophilin of immunocompetent lymphocytes, especially T-lymphocytes. This complex of cylosporine and cyclophilin inhibits calcineurin, which under normal circumstances induces the transcription of IL They also inhibit lymphokine production and IL release, leading to a reduced function of effector T-cells.

Cyclosporine is used as a mouth rinse or topically with adhesive bases in OLP. However, the solution is prohibitively expensive and should be reserved for highly recalcitrant cases of OLP. Systemic absorption is very low. Tacrolimus, also a calcineurin inhibitor, is a steroid-free topical immunosuppressive agent approved for the treatment of atopic dermatitis.

It is 10— times as potent as cyclosporine and has greater percutaneous absorption than cyclosporine. It has been successfully used in recalcitrant OLP cases. This substance is produced by Streptomyces tsukubaensis and belongs to the macrolide family.

The immunosuppressive action of tacrolimus is similar to that of cyclosporine, although it has a greater capacity to penetrate the mucosa. It inhibits the first phase of T-cell activation, inhibiting the phosphatase activity of calcineurin. Burning sensation is the commonest side effect observed; relapses of OLP after cessation have also been observed.

Pimecrolimus inhibits T-cell activation by inhibiting the synthesis and release of cytokines from T cells. Pimecrolimus also prevents the release of inflammatory cytokines and mediators from mast cells.

Pimecrolimus has significant anti-inflammatory activity and immunomodulatory capabilities with low systemic immunosuppressive potential. Topical retinoids such as tretinoin, isotretinoin and fenretinide, with their immunomodulating properties, have been reported to be effective in OLP. Reversal of white striae can be achieved with topical retinoids, although effects may only be temporary. Systemic retinoids have been used in cases of severe lichen planus with variable degree of success.

The positive effects of retinoids should be weighed against their rather significant side effects like cheilitis, elevation of serum liver enzymes and triglyceride levels and teratogenicity. As an antibacterial agent, dapsone inhibits bacterial synthesis of dihydrofolic acid and hence is used in the treatment of leprosy. When used for the treatment of skin diseases, it probably acts as an anti-inflammatory agent by inhibiting the release of chemotactic factors for mast cells.

Glucosephosphate dehydrogenase G6PD deficiency can increase the risk of hemolytic anemia or methemoglobinemia in patients receiving dapsone. Screening for G6PD deficiency is required before prescribing dapsone.

Hypersensitivity reaction to dapsone called Dapsone reaction is frequent in patients receiving multiple drug therapy. The symptoms of rash, fever and jaundice generally occur within the first 6 weeks of therapy and can be ameliorated by corticosteroid therapy.

Originally used to treat psoriasis, mycophenolic acid now reformulated as mycophenolate mofetil has been reintroduced in dermatological medicine. Being a very well-tolerated immunosuppressive drug used in organ transplant, it has been successfully used to treat severe cases of OLP. Mycophenolates are quite expensive and effective with long-term usage. Low-dose heparin devoid of anticoagulant properties inhibits T lymphocyte heparanase activity which is crucial in T-cell migration to target tissues.

This promises to be a simple, effective and safe treatment for OLP when injected subcutaneously as it has no side effects. It is a recombinant humanized monoclonal antibody which is used as an immunosuppressant in the treatment of psoriasis. Efalizumab, a monoclonal antibody to CD11a, binds to this adhesion molecule and causes improvement in OLP by decreased activation and trafficking of T lymphocytes.

It is administered once a week as a subcutaneous injection. It is currently an approved drug for the treatment of plaque psoriasis. This non-pharmacologic approach uses photochemotherapy with 8-methoxypsoralen and long wave ultraviolet light PUVA. Psoralens are compounds found in many plants, which make the skin temporarily sensitive to UV radiation. Methoxypsoralen is given orally, followed by administration of 2 hours of UV radiation intraorally in the affected sites.

It has been successfully used in the treatment of severe cases of OLP. Also, dosimetry can be difficult within the complicated geometry of the mouth, because PUVA is usually administered on skin over large, open surfaces.

Photodynamic therapy PDT is a technique that uses a photosensitizing compound like methylene blue, activated at a specific wavelength of laser light, to destroy the targeted cell via strong oxidizers, which cause cellular damage, membrane lysis, and protein inactivation.

PDT has been used with relative success in the field of oncology, notably in head and neck tumors. PDT is found to have immunomodulatory effects and may induce apoptosis in the hyperproliferating inflammatory cells which are present in psoriasis and lichen planus. This may reverse the hyperproliferation and inflammation of lichen planus. In patients who are suffering from painful erosive OLP and are unresponsive to even topical superpotent corticosteroids, surgical management using cryosurgery and different types of laser have also been tried.

A nm Diode laser,[ 30 ] CO 2 laser evaporation,[ 31 ] biostimulation with a pulsed diode laser using nm pulsed infrared rays[ 32 ] and low-dose excimer nm laser with UV-B rays have been tried. A deeper penetrating beam like the diode laser destroys the underlying connective tissue with the inflammatory component along the epithelium. The few studies documented show a lot of promise, but their effectiveness is yet to be proven. No therapy for OLP is completely curative; the goal of treatment for symptomatic patients is palliation.

The following [ Figure 2 ] simple systematic protocol will aid in effective treatment. Relief can be achieved in a majority of cases through topical application of corticosteroids, with or without the combination of other immunomodulators.

Very rarely does the condition necessitate systemic therapy. Laser therapy and other recent modalities are tried as the final remedy.

Oral lichens planus