Lichen sclerosus of the oral mucosa: a hidden phenomenon

Abstract

Oral lichen sclerosus (OLS) represents a diagnostic challenge even for expert dermatologists due to its rarity and subtle clinical manifestations. Only few cases have been reported in literature to date. OLS typically presents with whitish macules in the oral cavity. Histopathological examination remains crucial for definitive diagnosis, with characteristic features including epithelial atrophy, subepithelial hyalinization, loss of elastic fibers, and lymphocytic infiltration. Management strategies vary depending on lesion size and symptomatic presentation, with topical or intralesional corticosteroids being the most commonly used treatment modalities. Long-term monitoring is recommended due to the potential for malignant transformation, although no cases have been reported to date. Greater awareness and understanding of OLS are essential for accurate diagnosis and effective management. Based on these findings, we recommend performing an accurate evaluation of the oral mucosa, especially when dealing with patients affected by genital or extragenital lichen sclerosus (LS). Moreover, we emphasize the importance of multidisciplinary collaboration between dermatologists and other specialists of oral disorders, such as dentists. This short review briefly summarizes available data on OLS, highlighting its diverse clinical presentations and diagnostic challenges. Despite its infrequent occurrence, OLS should be considered in the differential diagnosis of white macules in the oral cavity.

Keywords: Inflammation; dermatology; lichen sclerosus; lip; oral mucosa.

Figure 1

Clinical (A,B) and histopathological (C) features of oral lichen sclerosus (OLS). (A) Clinical image of porcelain/ivory-like whitish macules in the oral cavity. (B) Schematic representation of the most common locations of OLS: palatal mucosa, gingiva and lower lip. (C) Graphical representation of histopathological changes in OLS: sclerosis confined to the superficial sub-epithelial layers (either papillary layer or in the submucosa); lymphocytic infiltration is also present at the dermal-epidermal junction and/or at the mucosal-submucosal interface. Created with Biorender.com.