Attack of white lines - oral lichen planus

Zhang Ailing said: "Life is a gorgeous robe, crawling with fleas. While enjoying the joy of life, you also have to endure the little annoyance of gnawing." And for the warm lining of the oral mucosa, there are also small annoyances that it cannot bear: no matter how gorgeous the lining is, white lines may crawl on it, such as oral lichen planus. Oral lichen planus (OLP) is a common chronic inflammatory disease that occurs in the oral mucosa. It is an interface inflammation that occurs in the oral mucosa.

1. History of white lines in oral lichen planus

Lichen planus is actually a chronic "mixed" disease of the skin and mucous membranes, which can affect the oral and genital mucosa, skin, nails and scalp, etc. Its name is also a mix of styles, "lichen" comes from the Greek, meaning tree moss, and "planus" is the Latin word for "flat". The name and description of oral lichen planus were first proposed by the famous British dermatologist Erasmus Wilson in 1869, who described the disease as "an eruption of papules, which develop in isolation and aggregation with their color, shape, structure". In 1892, Kaposi reported the first clinical variant of the disease. In 1895, Wickham noticed the characteristic reticular white lines on the surface of LP papules, which are known as "Wickham lines" today. Daryl formally described the histopathological changes associated with LP for the first time.

2. Oral lichen planus white streaks illustration

The lesions of oral lichen planus are white lines formed by small papules, which can form a variety of shapes such as a network, a tree branch, and a ring. They can also appear as white patches. They can occur in any part of the oral mucosa, but are most common in the cheeks. Patients feel that the mucosa is rough and uncomfortable, and are sensitive when eating irritating foods. There is obvious pain when there is congestion and erosion.

3. Origin of white lines in oral lichen planus

The cause of oral lichen planus and how the white lines crawl onto the mucosa are still unclear. Current academic research believes that: on the basis of heredity and genes, combined with infection, endocrine, psychological and mental factors, changes in the local microenvironment, etc., the first and second defense barriers of the mucosa are breached, and the third immune barrier comes into direct contact with immune cells, causing a disorder of the local immune response dominated by T lymphocytes, forming a protracted local mucosal interface inflammation.

4. Misconceptions about oral lichen planus

(1) Is lichen planus a type of ringworm?

Although the name contains "moss", it is different from psoriasis and is not caused by fungal infection.

(2) Does the presence of white lines mean there is cancer?

Since Francois Henri Hallopeau reported the first case of cancer associated with oral lichen planus in 1910, oral lichen planus has been in a state of "white terror". Whether oral lichen planus can turn into cancer has also caused endless debate among doctors from all over the world. In 1997, the authoritative World Health Organization (WHO) classified it as a precancerous state based on a large number of previous clinical studies, temporarily calming the dispute. Long-term erosive lichen planus does have the phenomenon of malignant transformation, but the probability of malignant transformation is not high, about 0.2-2%.

5. Oral lichen planus white streak removal surgery

According to the different clinical and pathological manifestations of oral lichen planus, oral mucosal doctors have corresponding standardized treatment plans. When many patients find white lines in their mouths, they often turn to the Internet for help: Leukoplakia? Lichen? Lupus erythematosus? Cancer? Incurable? ... The Internet is full of all kinds of information that is difficult to distinguish between true and false. It is easy to get trapped in the middle of the Internet, getting deeper and deeper into confusion. "If you are sick, check Baidu, and make a will after reading it."

In fact, for oral lichen planus and other stripe diseases including lichen planus, if you want to solve this white puzzle, you only need to master the three "membrane method" weapons in the membrane world: (1) Seek help from professional doctors, standardize medication, and have regular checkups. (2) Relax your mind. Emotional and psychological factors such as tension and anxiety will make the condition worse, or cause repeated attacks and protracted illness. After physical and mental adjustments, the condition can be alleviated, and some patients can even recover on their own. (3) Remove local irritants to the oral mucosa. Quit smoking, drinking, betel nuts, and various irritating foods that are too hot or sour and spicy. Wash your teeth regularly to remove plaque and keep your oral hygiene clean.

References

(1) Chen Qianming, ed. Oral Mucosal Pathology, Beijing, People's Medical Publishing House, 2020, 5th edition: 87-93.

(2) Farhi D, Dupin N. Pathophysiology, etiologic factors, and clinical management of oral lichen planus, part I: facts and controversies. ClinDermatol. 2010 Jan-Feb;28(1):100-8. doi: 10.1016/j.clindermatol.2009.03.004.PMID: 20082959.

(3) Pallavi Parashar. Oral Lichen Planus. Otolaryngol Clin N Am 44 (2011)89–107