Introduction
Lichen planus is a mucocutaneous disease that primarily affects the oral mucosa. It may also involve other mucosal and non-mucosal sites, including the esophagus, genitals, skin, and nails. Oral lichen planus (OLP) affects approximately 1% of the general population and is classified as an oral potentially malignant disorder, with reported malignant transformation rates ranging from 1.14% to 2.28%. Diagnosis is based on clinical examination and biopsy.
Recent evidence suggests that individuals with OLP may have an increased risk of systemic diseases that can substantially affect general health, quality of life, and oral health. Many of these conditions are chronic and may also increase the risk of certain cancers. Because people may be unaware of these comorbidities, the conditions may remain undiagnosed or unmanaged when they first consult an oral health practitioner. However, the available research has important limitations and inconsistencies, and the biological mechanisms linking OLP with systemic disease remain poorly understood.
Objective
This review critically examines the association between systemic diseases and oral lichen planus, a prevalent autoimmune disorder of the oral mucosa with malignant potential.
Discussion
Research indicates that individuals with OLP may be at increased risk of diabetes; Hashimoto thyroiditis; hypothyroidism; hyperthyroidism; celiac disease; hepatitis B and C; steatohepatitis; liver cirrhosis; and mental health conditions, including depression, anxiety, and stress.
Understanding these associations can help oral health and medical practitioners manage clients with OLP, as many individuals may be unaware that they have related systemic conditions. Certain conditions, such as diabetes, may contribute to OLP development or progression. Additionally, several associated comorbidities increase the risk of cancers affecting the liver, thyroid, small intestine, and oral cavity. Overall, current evidence indicates that systemic diseases are more common among individuals with OLP compared to the general population.
Conclusions
OLP is associated with several comorbidities that oral health and medical practitioners should recognize when managing clients with OLP. Current evidence suggests a higher prevalence and risk of diabetes, thyroid disorders, celiac disease, liver disease, and mental health conditions among clients with OLP than among the general population. Clinicians should consider how these conditions may affect OLP management. Appropriate measures may include monitoring blood glucose and blood pressure; recognizing symptoms of thyroid dysfunction or celiac disease; remaining alert to asymptomatic liver disease, particularly hepatitis B, hepatitis C, and steatohepatitis; and referring clients with mental health conditions to mental health professionals. These recommendations reflect the currently available evidence. Further well-designed studies are needed to clarify causal pathways and establish precise, evidence-informed management strategies for clients with OLP and systemic disease.
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