Oral Lichen Planus: A Clinical Puzzle in Evolution – A Review Article.

Abstract

Introduction: The oral cavity serves as a mirror of systemic health, often displaying early manifestations of systemic diseases. Among these, Oral Lichen Planus (OLP) is a chronic mucocutaneous inflammatory condition that primarily affects the stratified squamous epithelium of the oral mucosa, and may also involve the skin, scalp, nails, and vaginal mucosa. OLP is considered a potentially malignant disorder with a higher prevalence in middle-aged females, especially between the ages of 30 and 60. In the Indian population, the prevalence is estimated between 0.1% and 1.5%. Early diagnosis and a clear understanding of its pathogenesis are essential for effective management.

Sources: Relevant literature was identified using databases such as PubMed, Scopus, and Google Scholar. Keywords included “oral lichen planus,” “pathophysiology,” “clinical features,” and “treatment.” Articles published in English over the last 20 years were prioritized, along with authoritative guidelines from dermatology and oral medicine associations.

Study Selection: Original research, systematic reviews, and consensus guidelines focusing on the epidemiology, etiology, clinical manifestations, diagnostic approaches, and management strategies of OLP were included. Studies examining immune-mediated mechanisms and histopathological findings were given particular importance.

Conclusion: OLP involves both antigen-specific immune responses — notably, CD8+ cytotoxic T cell activation — and non-specific mechanisms such as mast cell degranulation and matrix metalloproteinase activity. Clinically, it presents with reticular, erosive, atrophic, or plaque-like lesions, often accompanied by burning sensations. Although benign in many cases, OLP carries a small risk of malignant transformation, necessitating long-term follow-up and biopsy of suspicious areas.

Clinical Significance: Understanding the multifactorial nature of OLP enhances diagnostic accuracy and enables tailored therapeutic approaches. Early recognition through oral examination allows for timely intervention, symptom relief, and reduction of malignant potential, making OLP a significant condition in both dental and medical practice.