Oral lichen planus management

Question 1

managemet of lichen planus

Answer 1

symptomatic – no treatment required
Symptoms – match treatment to symptom severity

Question 2

management options for oral lichen planus

Answer 2

• Diet modification
• SLS free toothpaste
• Topical analgesic
• Topical steroid
• Regular reviews, 6 monthly, potentially malignant mucosal disorder

Question 3

topical analgesics

Answer 3

• benzydamine mouthwash or oromucosal spray
• Lidocaine ointment 5%
• Lidocaine spray 10%

Question 4

topical antimicrobial

Answer 4

chlorohexidinde mouthwash

Question 5

topical steroid

Answer 5

-betamethasone soluble tablets 500 micrograms (as a mouthwash)
-Clenil modulate 50 micrograms/metered inhalation (beclometasone
diproprionate)
-hydrocortisone oromucosal tablets

Question 6

triple mouthwash given in secondary care components

Answer 6

Betamethasone 500microg soluble tablet, doxycycline 100mg dispersible tablet, nystatin suspension
1ml in 10 to 15ml water

Question 7

Oral lichen planus - Management in Secondary Care

Answer 7

topical steroids
triple mouthwash
systemic medication

Question 8

systemic medication given in secondary care

Answer 8

• short course of prednisolone
• disease-modifying antirheumatic drugs (DMARDs) e.g. hydroxychloroquine, azathioprine,
  mycophenolate mofeti

Question 9

Oral lichenoid reactions - Management

Answer 9

Liaise with GMP to cease/replace implicated medication
* Consider replacement of culpable restorative material with an alternative
* Interim management as per oral lichen planus
* Review 3 months above changes made to check response
* Potential for malignant transformation may be higher than for oral lichen planus