Oral lichen planus and other chronic mucosal conditions.

Oral lichen planus is the most common chronic inflammatory condition affecting the oral mucosa. It's classified as an immune-mediated condition — the body's immune cells target the basal layer of the mucosa, producing visible changes in the surface tissue.

The condition has several recognised forms, from quiet white lacy patterns (reticular lichen planus) to red, eroded areas that are painful when eating (erosive lichen planus). Some patients have multiple forms in different areas of the mouth at the same time.

• White lacy or web-like patches on the inside of the cheeks, tongue, or lips
• Red, inflamed patches that may be painful or sensitive
• Eroded areas or ulcers that feel like persistent sores
• Burning or stinging when eating spicy, acidic or hot food
• A sensation of roughness inside the mouth
• Skin or nail changes elsewhere (lichen planus can affect skin and nails too)

Some patients have visible patches with no symptoms at all — the condition is found incidentally during a routine examination.

Oral lichen planus is usually a clinical working diagnosis — the classic lacy pattern (Wickham's striae) is often recognisable on its own. Where we are unsure, a biopsy may be done to rule out other conditions that can look similar (lichenoid drug reactions, leukoplakia, certain autoimmune diseases).

A biopsy is a brief in-practice procedure under local anaesthetic (intra-oral injections). Results return from the laboratory within 10 to 14 days.

There is no cure for oral lichen planus — but for most patients the condition can be well managed with the right approach. The asymptomatic reticular form often needs no active treatment, just regular monitoring.

Symptomatic and erosive forms typically respond to topical corticosteroids, with systemic therapy reserved for severe or refractory cases. The trigger is largely unknown, but stress may contribute.

Because a small percentage of cases carry a slightly increased risk of malignant transformation, regular specialist review is part of the management plan — typically every six to twelve months depending on the type and severity.