Oral lichen planus: key features of etiopathogenesis, diagnosis, and management

Oral lichen planus (OLP) is a chronic inflammatory autoimmune disease of unknown etiology. It is assumed that a genetic predisposition contributes to the development of the disease and influences the patient's response to various etiological factors such as autoimmune reactions to epithelial antigens, microorganisms, and stress. Immunopathogenesis is primarily driven by cell-mediated immune mechanisms, with T lymphocytes playing a central role. The clinical presentation of OLP is varied, and multiple clinical forms can occur in the same patient. OLP is categorized into six clinical types: reticular, papular, and plaque-like (hyperkeratotic variants), and atrophic, erosive, and bullous (erosive variants). The histopathological diagnosis of OLP is unique. Continuous follow-up of patients is crucial because OLP is considered an oral potentially malignant disorder (OPMD). Reported rates of malignant transformation vary, with a pooled estimate of 1.43% for OLP and 5.13% for OLP with dysplasia. Patient education plays a crucial role in treatment initiation and planning. A personalized treatment approach focuses on controlling inflammation and relieving symptoms such as pain and burning. Treatment should be individualized according to disease severity, subtype, and patient response, with constant monitoring for possible malignant transformation and comorbidities.