Oral lichenoid lesions - a review and update

Abstract

Background: Oral lichenoid lesions or reactions (OLLs/OLRs) are clinical and histological contemporaries of the classical oral lichen planus (OLP) that have generated a lot of debate in literature. In contrast to the idiopathic nature of OLP, OLLs are often associated with a known identifiable inciting factor. A superficial examination of these lesions clinically and histologically often reveals many similarities with OLP, but recent data indicate that distinguishable features do exist and form the basis of most classifications.

Aims and objectives: This paper attempts to collate available data in English literature on OLLs, highlight distinguishing features clinically and histologically and reflect on the malignant transformation potential and treatment modalities of the condition.

Materials and methods: A comprehensive search of medical and dental databases including PubMed, Ovid, Cochrane, Pubget, Researchgate, and non-medical search engines were utilized for the review. The search words included "oral lichen planus", "oral lichenoid lesions", "oral drug reactions", "lichenoid dysplasia", and "adverse effects of dental materials".

Review results: OLLs seem to grossly underrated and most cases were clubbed as OLP. Definite clinical and histological features were uncovered to establish the identity of this lesion. Associations with dental restorative materials, drugs, and medications have been conclusively proven in the etiology of this condition. Specific markers are being utilized to diagnose the condition and monitor its progress.

Conclusion: Substantial differentiating features were uncovered to delineate OLLs as a separate entity with definite etiology, pathogenesis, and a high malignant transformation rate compared with OLP.

Keywords: Drug association; literature review.malignant transformation; oral lichen planus; oral lichenoid lesions; oral lichenoid reactions.

Figure 1

Clinical presentation of the lesion next to an old amalgam restoration (Courtesy: Dr Lavanya Sundaram)

Figure 2

A more classical oral lichen planus (OLP) like presentation in another case with proximity to amalgam restorations

Figure 3

Histopathological image of biopsy from case 2 showing diffuse proliferation of lymphocytic cells with increased vascularity and perivascular concentration of inflammatory cells (hematoxylin and eosin (H and E, ×10))

Figure 4

Histopathological image of biopsy from case 1 showing a more OLP like presentation (H and E, ×10)

Figure 5

Histopathological image of classical OLP showing compact band of subepithelial lymphocytic inflammatory infiltrate with hyperkeratosis and saw-tooth shaped rete ridges (H and E, ×10)

Figure 6

Classical immunofluorescent presentation of oral lichenoid lesions (OLL)