[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Dentistry](https://durgical.com/en/dentistry/) › [Oral mucosal lesions](https://durgical.com/en/dentistry/areas/oral-lesions/) › Oral lichen planus

# Oral lichen planus

- Oral pathology

A chronic immune condition that draws lacy white lines on both cheeks. Most cases are painless; erosive forms hurt and need follow-up.

Updated Nov 12, 2026

## Key points

- Lacy white lines on both cheeks = lichen planus.
- Erosive forms hurt; topical corticosteroids are first line.
- Small malignant risk: review periodically and biopsy changes.

## What it is

Oral lichen planus is a chronic T-cell–mediated inflammatory disease of the oral mucosa, most common in middle-aged women. The reticular form shows lacy white lines (Wickham striae), typically on both buccal mucosae, and is usually painless. Erosive and atrophic forms give red, sore areas and ulcers and can involve the gums as «desquamative gingivitis». Skin, nail, genital and scalp lesions may coexist. Lichenoid reactions look the same but are caused by drugs (such as some antihypertensives, antimalarials and NSAIDs) or by contact with amalgam fillings, and resolve when the cause is removed.

## How to recognise it

- Bilateral, symmetrical lacy white striae on the buccal mucosa.
- Erosive forms: pain with spicy food, red areas, ulcers, desquamative gingivitis.
- Biopsy confirms when the appearance is atypical, ulcerated or unilateral.
- Lichenoid reactions to drugs or fillings mimic it; one-sided lesions next to an amalgam suggest contact.
- A small risk of malignant change exists, mainly in erosive and red forms.

## Differential and risks

- Hepatitis C infection has been associated with lichen planus in some populations.
- Desquamative gingivitis can also be mucous membrane pemphigoid or pemphigus: biopsy decides.
- Treatment controls symptoms but rarely cures; flares are common.

## Next step / Initial management

- Painless reticular lesions: reassurance, good oral hygiene, avoiding tobacco and irritants, and periodic review.
- Symptomatic erosive lesions: topical corticosteroids are first line; refer to oral medicine or the dentist for biopsy and management.
- Review drugs and fillings for lichenoid reactions; any persistent ulcer, induration or change in appearance needs referral for biopsy.

## Test yourself

Think of the answer, then tap the question to see it.

## What is the typical appearance and site of reticular oral lichen planus?

Lacy white lines (Wickham striae) on both buccal mucosae, symmetrically.

## What is a lichenoid reaction?

A lesion that looks like lichen planus but is caused by a drug or contact with a filling, and resolves when the cause is removed.

## What is the first-line treatment of symptomatic erosive oral lichen planus?

Topical corticosteroids, with oral hygiene and avoidance of irritants.

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## Connections

## Related 3

- [White and red patches in the mouth: approach](https://durgical.com/en/dentistry/white-and-red-patches-in-the-mouth-approach/)
- [Blisters and erosions: pemphigus, pemphigoid and erythema multiforme](https://durgical.com/en/dentistry/blisters-and-erosions-pemphigus-pemphigoid-and-erythema-multiforme/)
- [Oral cancer screening: who, what to look for, when to biopsy](https://durgical.com/en/dentistry/oral-cancer-screening-who-what-to-look-for-when-to-biopsy/)

## Related conditions 1

- [Lichen planus](https://durgical.com/en/conditions/lichen-planus/)

## In Pharmacology 1

- [Corticosteroids (glucocorticoids)](https://durgical.com/en/pharmacology/classes/corticosteroids/)

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Educational content; it does not replace assessment by a dentist or doctor and is not a clinical instruction. For facial or neck swelling with difficulty swallowing or breathing, a knocked-out tooth or bleeding that will not stop, go to an emergency department at once.

Sources: [Oral Lichen Planus](https://www.ncbi.nlm.nih.gov/books/NBK578201/) (StatPearls Publishing (NCBI Bookshelf), 2025); [Immune-Mediated Oral Mucosal Diseases](https://www.ncbi.nlm.nih.gov/books/NBK597383/) (StatPearls Publishing (NCBI Bookshelf), 2023).

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Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/dentistry/oral-lichen-planus/