Clinical case
A 45-year-old woman presents to the oral medicine clinic with a 6-month history of burning discomfort affecting the inside of her cheeks, particularly when eating spicy or acidic foods. She also reports a “rough” feeling in the mouth and occasional sensitivity when brushing her teeth.
On examination, there are bilateral white, lace-like striations on the buccal mucosa, with areas of surrounding erythema and superficial ulceration. The lesions are symmetrical and persistent. No skin, genital, or ocular lesions are reported.
Pathophysiology
Oral lichen planus (OLP) is a chronic immune-mediated inflammatory disease affecting stratified squamous epithelium. It is considered a T-cell–mediated interface mucositis.
Key mechanisms include:
CD8+ cytotoxic T-lymphocyte–mediated apoptosis of basal keratinocytes.
Up regulation of inflammatory cytokines including TNF-α, IL-2 and IFN-γ.
Degeneration of the basal cell layer leading to epithelial separation from the underlying connective tissue.
Band-like lymphocytic infiltrate at the epithelial–connective tissue interface.
Possible antigenic triggers including drugs, dental materials, infections and stress in some cases.