Clinical Aspects of Oral Lichen Planus in a Group of Sri Lankan Patients

Abstract

The aim of this study was to determine clinical characteristics of oral lichen planus (OLP) in a group of Sri Lankan patients who attended the Dental Hospital for treatment.

A total of 104 patients with oral lichen planus who attended the Oral Medicine clinic, Faculty of Dental Sciences, during the period from January 2001 to December 2003 were included in the study. Information pertaining to demographic data, duration of oral lesions and existence of skin lesions were obtained and site and types of the lesions were recorded. Patients with the history of current usage of drugs known to cause lichenoid reactions and with amalgam fillings associated with lesions were excluded from the study. Incisional biopsies were taken from lesions of all the patients in order to confirm the diagnosis.

The mean age of the study population at the time of presentation was 45 years and the highest number of cases was found in the age group of 45-55 years (χ²=20.26, df=5, P=O.OO1). Females outnumbered males (1.5: 1). The mean period of experience of the disease before seeking treatment was 4.4 months. 16.3% (n=17) had no symptoms and the rest had feelings of roughness, burning sensation at meal times and spontaneous mucosal burning. There was no gender difference with respect to symptoms (χ²=3.323, df=3, P=O.344). Fourteen patients (13.5%) had shown skin lesions. Six clinical types were identified namely reticular (58.7%), papular (1.9%), plaque like (3.8%), atrophic (2.9%), ulcerative or erosive (6.7%) and lesions with combination of different morphological variants (26%). There was no gender difference with regards to the different clinical types (χ²=5.769, df=5, P=O.329). All patients with atrophic and erosive/ulcerative types had burning sensation as the main symptom. Forty-eight out of 61 patients (78.6%) with reticular type and 19 patients out of 27 (70.3%) with mixed types had burning sensation at meal times. Common sites of affliction were left buccal mucosa (76.9%), right buccal mucosa (75%), dorsum of the tongue (16.3%), lower vermilion border (10.6%) and gingiva (7.7%). The most frequent mucosal combination was the left and right buccal mucosa affecting 66 patients (63.5%). Eighty-seven patients (83.6%) needed therapeutic management and the mainstay of treatment was corticosteroids. Only eight patients (7.7%) needed the use of systemic steroids to control their symptoms.

The age and sex distribution of the present cohort resembles that of the other studies on OLP patients. Reticular type was the commonest in the present study and similar results were found in other studies. Buccal mucosa was the commonest site of affliction. There were no cases with evidence of dysplasia or transformed to malignancy. Furthermore, it was not possible to comment on the treatment outcome or the malignant transformation at this stage of the study as the present group of patients is on follow up.