Clinical Patterns of Oral Lichen Planus

Lichen planus involving the oral cavity may present with one or more clinical patterns.

Clinical patterns recognized by the World Health Organization:

(1) reticular

(2) papular

(3) plaques

(4) atrophic

(5) erosive

(6) ulcerated

(7) bullous

The ulcerated pattern is considered by some to be a later phase of the bullous pattern.

Features	Reticular	Erosive
frequency	most common	second most common
appearance	violet-erythematous area with whitish striae forming a network; may be hyperpigmented (postinflammatory hyperpigmentation)	few to multiple mucosal erosions with or without a pseudomembrane
distribution	bilateral involvement; buccal mucosa, lateral tongue, lips	usually associated with reticular lesions
symptoms	usually asymptomatic	painful with burning sensation triggered by foods, smoke or irritants; may have metalic taste

Features	Plaque	Atrophic
frequency	seen in smokers
appearance	one to multiple lesions with flat to irregular whitish surface; may resemble leukoplakia	symmetrical with whitish striae at the periphery
distribution	dorsal surface of tongue and buccal mucosa	may be diffuse in the oral mucosa; may prefer gingiva or dorsum of tongue
symptoms	usually asymptomatic	painful with burning sensation triggered by foods, smoke or irritants

Features	Papular	Bullous
frequency	rare	rare
appearance	small whitish papules 0.5 mm in diameter	vesicles and/or bullae early, painful ulcerations later
distribution		buccal mucosa, usually adjacent to second and third mandibular molars, lateral portion of tongue
symptoms	usually asymptomatic	very painful with burning sensation triggered by foods, smoke or irritants

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