Do you have any information about lichen planus in the mouth and throat? I have had laser surgery in my mouth three times, but then the lichen planus appears in other areas in my mouth that have not been lasered. Is this the only solution?

C.B.

Oral lichen planus is an inflammatory condition of the mucus membranes (mucosa) and/or skin. The cause is unknown. Usually, the diagnosis can be made when a doctor sees lacy, thin white lines on the oral mucosa, usually on the inside of the cheeks. While this is probably the most common presentation of oral lichen planus, there are also ulcerative/erosive forms of this disorder (which cause open sores) as well as an atrophic form (in which the mucosa is dull red, and the lines are present only at the edges of the red patches).

While the cheek mucosa is the most commonly afflicted area, the tongue, lips, palate and gums may also be involved. Oral lichen planus is often a nonpainful condition that is detected by a dentist or primary-care physician, who then refers the patient to an ear, nose and throat specialist (ENT) because of a concern for oral cancer. If there is any doubt, one or two small biopsies of the affected mucosa can usually establish a definitive diagnosis.

Once the concern for cancer has been alleviated, oral lichen planus need be treated only if the lesions are painful. I am not familiar with the use of laser for treatment of oral lichen planus. Topical therapy is, by far, the most common treatment. A variety of medicated mouthwashes are available. Such a mouthwash, combined with a topical anesthetic, can relieve the pain in many individuals. For more stubborn cases, topical corticosteroids can be applied to the lesions. If this fails, the lesions can be injected with corticosteroids. Finally, if the lesions are very extensive, a short trial of oral corticosteroids may be necessary. Unfortunately, oral corticosteroids have a wide range of fairly nasty side effects; you should certainly review these with your doctor before embarking on a course of oral steroids!

Retinoids have been used to treat severe cases of oral lichen planus. Retinoids are close relatives of vitamin A; they are very useful in the treatment of severe acne. Retinoids, however, are also associated with side effects. By far the nastiest side effect of the retinoids is that, if they are taken by a pregnant woman, SEVERE birth defects can result.