Erosive lichen planus (ELP) is an uncommon variant of oral lichen planus that is chronic and sometimes untreatable, according to the Mayo Clinic. The condition is painful, most commonly affecting the oral mucosa. It can affect mucosa in other parts of the body including the esophagus, genitals and the skin. It is not contagious, but instead believed to be a result of the body's own immune system attacking the oral mucosa. It's origin is unknown, making treatment a challenge.
Symptoms and Complications of Erosive Lichen Planus
In the mouth, erosive lichen planus lesions can be found inside the cheeks, on the sides of the tongue, on the gums or inside the lips. The tissue appears swollen and bright red due to the loss of the top layer of the mucosa. This tissue can become infected, which can cause scarring after healing. Unlike shorter-lasting canker sores, erosive lichen planus lesions can be larger and more irregular and last for weeks or longer. This results in severe pain with eating and can lead to weight loss, nutritional deficiencies and depression.
Erosive Lichen Planus: Causes and Risk Factors
According to the American Academy of Oral Medicine, lichen planus affects 2 percent of the population, with women older than age 50 being the most commonly affected. The condition can occur in any adult, though, and it's within this population that the uncommon variant ELP can develop.
While the exact cause is not well understood, experts suspect that T lymphocytes — the white blood cells identified with inflammation — are triggered in lichen planus. ELP may also be connected to an auto immune disorder, though more research is needed to confirm this link.
Diagnosis of Erosive Lichen Planus
A doctor usually diagnoses ELP through a clinical exam and a review of health conditions and medications. Since the condition is chronic, doctors closely monitor for changes in the appearance of the erosive ulcerations. Monitoring can include blood tests, biopsies and cultures to identify the origin of the lesion and rule out other oral conditions.
Treatment for Erosive Lichen Planus
According to a Cochrane Review, current medical treatments are not very effective. Treatment options, including topical and inhaled corticosteroids and aloe vera gel, showed weak evidence for decreasing symptoms across studies. Eating a bland diet that eliminates spicy, salty, and acidic food is best especially while lesions are present. Also, managing stress and avoiding alcohol and tobacco can help diminish symptoms.
Regular dental visits are also important. Your dentist or dental hygienist will routinely check the oral soft tissues to manage lichen planus and monitor for changes or worsening of this condition. They will stress good oral hygiene and may recommend a soft-bristled toothbrush.
Self care is critical to managing erosive lichen planus. This chronic condition can be controlled but not cured, so working with your dentist and other health care providers can help you manage your health and follow the most effective treatment plan.