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 |
Specialty: Otolaryngology