Oral Lichen Planus

Lichen planus is a mucocutaneous inflammatory disease. OLP is clinically different from the dermal counterpart but has similar histopathology. The mechanism of the disease is thought to involve a cell-mediated immune response induce by an antigenic change in the mucosa. A variety of antigens have been proposed which include drugs, viral and bacterial infections, and amalgam restorations. The majority of patients are middle-aged with a slight female predominance (60%). A number of clinical variants have been described (erosive, atrophic, and hypertrophic) and exist with a notable amount of overlap.

A number of reports of malignant transformation of OLP exist (83). Malignant transformation of OLP is still controversial and the reported rates of malignant transformation range from 0% to 5.6% (83-85). A lack of consensus as to the exact criteria used in the clinical and histopathologic diagnosis of OLP has confounded the matter. The diagnosis of OLP may be complicated by some overlap with other entities such as chronic discoid lupus erythematous and leukoplakia. Aggressive use of steroids for treatment of OLP has been proposed as a possible reason why OLP patients may be vulnerable to malignant transformation (86). Clinicians should have a high index of suspicion of patients with OLP developing an oral malignancy. The clinical variants most often associated with the transformation are the erosive and atrophic forms. In one study based on the outcome of 832 patients, investigators found a transformation rate of 0.8% and recommended a follow-up of at least six years for patients with OLP (83).

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