Oral Lichen Planus: Current Evidence, Clinical Challenges, and the Search for Optimal Management

Oral lichen planus (OLP) is a chronic, immune-mediated inflammatory disease of the oral mucosa with an incompletely understood etiology and a diverse clinical presentation. Because OLP is often refractory and follows a chronic or relapsing course, accurate diagnosis and appropriate long-term management remain important clinical challenges. The diagnosis of OLP is based on clinical findings and histopathological examination, with consideration of a variety of conditions that may mimic OLP, including oral lichenoid lesions, autoimmune blistering diseases, candidiasis, and leukoplakia. Management is primarily aimed at controlling inflammation and alleviating symptoms. Elimination of precipitating or aggravating factors, improvement of oral hygiene, and appropriate dental treatment are important components of long-term disease management. Topical corticosteroids remain the mainstay of local therapy, while topical calcineurin inhibitors, such as tacrolimus and pimecrolimus, may provide useful alternatives, particularly in steroid-refractory cases. Laser therapy may also be considered as an adjunctive treatment in selected patients. Systemic corticosteroids are generally reserved for severe, extensive, or refractory disease. In addition, various adjunctive and alternative therapies, including herbal medicines, phytochemicals, vitamins, micronutrients, hydroxychloroquine, and methotrexate, have been investigated. Although several of these approaches have shown promising therapeutic effects, the available evidence remains limited and further high-quality clinical studies are required. OLP is currently classified among the oral potentially malignant disorders, although the magnitude of its malignant transformation risk remains debated. Therefore, long-term surveillance is important because some patients may develop oral squamous cell carcinoma. At present, the management of OLP focuses primarily on symptom relief and disease control rather than cure. A comprehensive and individualized approach that integrates accurate diagnosis, elimination of aggravating factors, oral health management, appropriate selection of topical and systemic therapies, and long-term surveillance is therefore important. Further clarification of the underlying mechanisms of OLP and well-designed clinical studies may contribute to more effective and individualized approaches to its diagnosis and management.