A sore and sensitive tongue

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A sore and sensitive tongue

J Fam Pract. 2005 January;54(1):33-36

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References

1. Eisen D. The clinical features, malignant potential, and systemic associations of oral lichen planus: A study of 723 patients. J Am Acad Dermatol 2002;46:207-214.

2. Gorsky M, Raviv M, Moskona D, Laufer M, Bodner L. Clinical characteristics and treatment of patients with oral lichen planus in Israel. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;82:644-649.

3. Allen CM, Blozis GG. Oral mucosal lesions. In Cummings CW, Schuller DE (eds): Otolaryngology: Head and Neck Surgery, vol 2, 2nd ed. St Louis, Mo: Mosby-Yearbook; 1993;1374-1375.

4. Eisen D. The evaluation of cutaneous, genital, scalp, nail, esophageal, and ocular involvement in patients with oral lichen planus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88:431-436.

5. Brown RS, Bottomley WK, Puente E, Lavigne GL. A retrospective evaluation of 193 patients with oral lichen planus. J Oral Pathol Med 1993;22:69-72.

6. Thorn JJ, Holmstrup P, Rindum J, Pindborg JJ. Course of various clinical forms of oral lichen planus. A retrospective follow-up study of 611 patients. J Oral Pathol 1998;17:213-218.

7. Porter SR, Kirby A, Olsen I, Barrett W. Immunologic aspects of dermal and oral lichen planus. A review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;83:358-366.

8. Rozycki TW, Rogers RS, Pittelkow MR, et al. Topical tacrolimus in the treatment of symptomatic oral lichen planus: A series of 13 patients. J Am Acad Dermatol 2002;46:27-34.

9. Kaliakatsou F, Hodgson TA, Lewsey JD, Hegarty AM, Murphy AG, Porter SR. Management of recalcitrant ulcer-ative oral lichen planus with topical tacrolimus. J Am Acad Dermatol 2002;46:35-41.

10. Olivier V, Lacour JP, Mousnier A, Garraffo R, Monteil RA, Ortonne JP. Treatment of chronic erosive oral lichen planus with low concentrations of topical tacrolimus. An open prospective study. Arch Dermatol 2002;138:1335-1338.

11. Hodgson TA, Sahni N, Kaliakatsou F, Buchanan JA, Porter SR. Long-term efficacy and safety of topical tacrolimus in the management of ulcerative/erosive oral lichen planus. Eur J Dermatol 2003;13:466-470.

12. Shen JT, Pedvis-Leftick A. Mucosal staining after using topical tacrolimus to treat erosive oral lichen planus. J Am Acad Dermatol 2004;50-326.

13. Trehan M, Taylor CR. Low-dose excimer 308-nm laser for the treatment of oral lichen planus. Arch Dermatol 2004;140:415-420.

Diagnosis: oral lichen planus

Compared with the more self-limited nature of its cutaneous counterpart, oral lichen planus (OLP) causes more chronic inflammatory lesions, resulting in increased morbidity and a greater therapeutic challenge for physicians. Of the 3 basic clinical morphologies of the disease (reticular, erythematous, and erosive), the last form tends to be more symptomatic and prompts patients to seek treatment.^1,2 The more asymptomatic reticular form is the most easily recognizable variant and may cause increased symptoms when involving the tongue, typically manifesting on the dorsal surface.¹

In contrast to reticular lesions in other oral sites, tongue lesions do not usually exhibit the characteristic interlacing pattern of white, raised striae; instead they manifest as well-demarcated areas with a patch-like pattern of erythematous, atrophic, and keratotic regions. ³ Erosive OLP more commonly involves the lateral tongue and displays erythematous or ulcerated areas with peripheral keratosis, forming fine centrifugal striae.³

Oral lichen planus affects approximately 1% to 4% of the population ⁴ and is seen most commonly in older women.^1,5,6 It has a predilection for bilateral involvement of the buccal mucosa but may also affect (in descending order of frequency) the tongue, gingiva, lips, floor of the mouth, and palate.^1,2 Isolated involvement of only 1 oral site is infrequent, with the exception of gingival lesions.¹ Extraoral cutaneous lichen planus has been reported in 16% to 44% of patients with oral disease; it most frequently involves the genital mucosa, as well as the scalp, nails, and esophageal and ocular mucosae.⁴ A multidisciplinary approach including generalists, dermatologists, otolaryngologists, ophthalmologists, and gynecologists may be necessary for patient evaluation and management.

Pathogenesis of oral lichen planus

Although the precise cause of OLP is unknown, its pathogenesis has been linked to an autoimmune mechanism involving autocytotoxic CD8+ T cells, which trigger apoptosis (programmed cell death) of basal keratinocytes.^4,7 An imbalance between T cell helper and suppressor activity has also been observed.^1,7

Complications: Carcinoma, chronic liver disease

Malignant transformation to squamous cell carcinoma (SCC) is seen in 0.4% to 5% of patients with OLP, particularly those with erosive and erythematous disease.^1,2 Increased risk factors for SCC have not been identified in these patients, but a greater prevalence of Candida albicansmay be associated with carcinogenesis, as may herpes simplex and human papilloma viruses, immunosuppressive therapy, and an inflammatory cytokine-rich microenvironment.¹

A sore and sensitive tongue

References

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