Oral Lichen Planus: a Study of 150 Cases

A study of oral lichen planus on 150 extending over 30 years was undertaken, a female predominance was noted. Most patients (47.3%) were from the intermediate and non manual worker class. The buccal mucosa (89.3%) followed by the gingival (39.3%) were found to be the most commonly affected sites. Soreness featured as the most common presenting complaint (56.6%). The keratotic lesion was the most frequent type. A history of chronic disease was noted in 79 patients while 22 of 91 patients (53%) investigated for surgical episodes gave a history of surgical episode within one year of onset. History of prolonged use of drugs was noted in 73 patients. Use of tobacco was noted in 43. Alcohol consumers totaled 79. Stress at onset was recorded in 105 patients. Denture wearers were noted at 38. Heavily restored teeth were recorded in 48 of 111 patients. Biopsy report was found to be consistent with clinical diagnosis in 108 patients out of 123 investigated while 15 reported non diagnostic lesions. Candidal infection was investigated in 68 patients (45%) and 34 (50%) were noted positive. Sideroperia was detected in 16 female patients (24.6%) out of a total of 97 patients in whom 65 were females. No iron deficiency was noted in males. Vitamin B12 deficiency was noted in 4 (5.3%) out of 75. Remission was noted in 4 patients and familial lichen planus was noted on two occasions. Malignant transformation was recorded at 2 percent. INTRODUCTION Natural History Lichen planus is a relatively common dermatosis that occurs on the oral mucus membrane as well. It was first described on the skin by Erasmus Wilson in 1869 who also recorded oral lesions in several patients. The classical description of papules, striations and plaques was provided by Unna in 1882. The striations are commonly called Wickhams striae although due credit to Wickhams original contribution is difficult to find in the literature. Further cases were reported by Crocker. The first description, of the now classical histological appearance was published by Dubreuilh in 1906 in which he also noted the similarity of oral and dermal lesions. The first independent oral lesions were reported by Audry in 1894 while Poor in 1905 was the first to describe a bullovesicular lesion. A malignant transformation was first noted by Hallopeau in 1910. In a review of the literature Trautman noted that the buccal mucosa was the most commonly affected site. Millan and Fouquet in 1929 first described ulcerative lesions while Lortal – Jacob et al. in the same year described atrophic lesions. A variant from the classical appearance of lichen planus in the form of lichen sclerosus et atrophicus on the skin was described by Hallopeau. Darier confirmed these findings in 1892 and since then the lesion is called lichen planus sclerosus et atrophicus. The natural history on the skin is one of spontaneous remission (Samman, Scully and El Kom1,) although lesions on the oral mucosa were reported to be persistent while specific types like the erosive variety may resolve (Samman 1972). One case of erosive lichen observed by Andreasen (1968) reportedly persisted for twenty five years. CLINICAL FEATURES Skin Lesions These are small angular, flat topped papules only a few millimeters in diameter (Schafer et al2). The papules are umblicated, well demarcated and the primary Asst Prof and Head of Dept of Oral Medicine. Faculty of Dentistry, Liaquat University of Medical and Health Sciences, Jamshoro ** Principal and Head ofDept of Oral Surgery, Liaquat Ali Khan, College ofDentistry and Darul Sehat Hospital Karachi *** Associate Professor, Pathology Dept Isra University, Hyderabad, — Pakistan