Oral lichen planus: symptoms, causes and treatment options

Oral lichen planus is a chronic inflammatory condition of the oral mucosa. It can cause fine white streaks, red patches, ulcers, a burning sensation or sensitivity to certain foods. Some forms do not cause any symptoms and are discovered during a routine dental check-up.

The condition is not contagious, and the exact cause is not fully understood. Symptoms can be managed through treatment and by minimising irritants, but regular monitoring remains important.

Where medication is indicated, it is prescribed by a dermatologist or ENT specialist, depending on the form and severity of the symptoms.

Oral lichen planus occurs when the immune system triggers an inflammatory reaction in the cells of the oral mucosa. Lesions may form on the inside of the cheeks, the gums, the tongue, the lips or the palate, and are often present on both sides. The course of the condition is chronic, with periods without significant symptoms alternating with episodes of flare-ups.

Diagnosis is based on clinical examination and medical history. In many cases, the doctor may recommend a biopsy, in which a small tissue sample is taken for microscopic examination. This investigation helps to confirm the diagnosis and rule out other conditions with a similar presentation.

The characteristic feature is Wickham’s striae: fine, white, net-like lines. White patches, red and thinned areas, ulcers or lesions may also appear, affecting the gums and giving them a red, sensitive appearance.

The reticular form is often asymptomatic. Atrophic, erosive or ulcerative forms may cause a burning sensation, stinging and pain, particularly when eating spicy, acidic, hot or hard-textured foods. If the gums are affected, brushing may become uncomfortable and bleeding may occur.

Lichen planus can sometimes also affect the skin, nails, scalp or other mucous membranes. The presence of symptoms outside the oral cavity should be reported to your doctor so that any necessary further investigations can be arranged.

The exact cause is unknown. The condition is thought to be immune-mediated: certain cells of the immune system attack the cells of the oral mucosa and maintain the inflammation. However, there is no single trigger that has been identified in all cases.

Genetic predisposition may contribute to the development of the condition, but oral lichen planus is not considered to be a condition passed directly from parents to children. Environmental factors, certain medicines, hygiene products and some dental materials can cause clinically similar lichenoid reactions, without necessarily representing oral lichen planus itself. A doctor must make the distinction.

What can aggravate lichen planus

Symptoms may become more severe upon contact with acidic, spicy, very hot or crunchy foods. Smoking, alcohol, poor oral hygiene, bacterial plaque and trauma caused by sharp tooth edges or poorly fitted dental restorations can perpetuate the irritation.

Some patients report stress in association with flare-ups, although this is not considered a direct cause of the condition. Identifying personal factors that exacerbate symptoms can help to manage them. 

Oral lichen planus can present as reticular, papular, plaque-like, atrophic, erosive or bullous. The reticular form presents with white streaks and is often asymptomatic. The atrophic and erosive forms produce red patches, ulcers and more pronounced discomfort, whilst the bullous form, which is rarer, manifests as blisters.

The appearance of the lesions is not sufficient for self-diagnosis. Several oral conditions may resemble lichen planus, but they have different causes, courses and treatments.

Asymptomatic lesions may not require drug treatment, but only monitoring. For painful forms, topical corticosteroids are often the first-line treatment. These may be prescribed as a gel, ointment, spray or mouthwash, depending on the location and severity of the lesions.

In extensive cases or those resistant to local treatment, the doctor may consider other anti-inflammatory or immunomodulatory medicines, including systemic treatments. The choice is made on an individual basis, as these medicines may have side effects and may require monitoring. Treatment aims to control inflammation and reduce symptoms; it does not promise a permanent cure.

How to treat lichen planus at home

Home care complements the treatment recommended by your doctor. It is advisable to use a soft-bristled toothbrush, a mild-tasting toothpaste and to maintain good oral hygiene. Foods that cause a burning sensation, such as acidic, spicy, very hot or hard foods, may be limited during periods when symptoms are present.

Do not use a gel for oral lichen planus or corticosteroid-based medicines without medical advice. White or ulcerative lesions may have different causes, and inappropriate treatment may delay the correct diagnosis.

As the exact cause is unknown, oral lichen planus cannot be definitively prevented. However, irritation and the severity of flare-ups can be reduced through good oral hygiene, avoiding tobacco and excessive alcohol consumption, treating dental problems and limiting foods that aggravate the symptoms.

Regular check-ups allow the lesions to be monitored. Any ulcer that does not heal, or any area that changes in appearance, becomes harder, bleeds or causes persistent pain, must be assessed without delay. Oral lichen planus is considered a condition with a low, but real, risk of becoming malignant, which is why medical supervision is necessary.

Early diagnosis helps to distinguish oral lichen planus from other lesions and to select the appropriate treatment. Consultation, a biopsy where indicated, and regular monitoring are central to long-term management.

Current research aims to identify the immunological mechanisms more precisely and to develop treatments that control inflammation more effectively. If you notice persistent lesions or discomfort in your mouth, book an appointment for a proper assessment.

If you notice persistent lesions or discomfort in the oral mucosa, consult your dentist for an initial assessment. If oral lichen planus is suspected, your dentist may recommend the necessary investigations and a consultation with a dermatologist or ENT specialist to determine the appropriate treatment. 

• American Academy of Oral Medicine (AAOM). Oral Lichen Planus. Updated in September 2013. Accessed on 24 August 2026.
• University College London Hospitals NHS Foundation Trust. Lichen Planus. Updated 28 May 2026. Accessed 24 August 2026.
• Manchanda Y, Rathi SK, Joshi A, Das S. Oral Lichen Planus: An Updated Review of Etiopathogenesis, Clinical Presentation, and Management. Indian Dermatology Online Journal. 2024;15(1):8–23. doi: 10.4103/idoj.idoj_652_22