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Tobacco Chewer. Noticed Burning White Patches In Mouth. Could It Be Lichen Planus Or Leukoplakia?

Posted on Wed, 6 Mar 2013

Question: Hi, My brother (Age-42) was a tobacco chewer for last 15 years. He was having mouth ulcer and poor oral hygiene. In 1st week of Dec’12 white patches appeared in his mouth. One surgery doctor prescribed for Leukoplakia treatment. On 2nd Jan’2013 Scrap Cytology was performed. Test Result - “NO MALIGNANT CELL. Only mild Inflammation was found “. Then he was referred to a Dentist. But dentist has mentioned the disease as “LICHEN PLANUS”. Sufficient reason for Leukoplakia is there but possible reason for Lichen Planus i.e. dental filling, Allergy to medicine, Malaria treatment are not there in his case. With use of steroid medicine one of the patche on the inner chick disappeared. But for last 4 to 5 days he reports on burning sensation of some the patches with slight reddish coloured spot. Today also the dentist examined his teeth and reported nothing serious. I am in a dilemma whether it is Leukoplakia OR Lichen Planus. If Oral Lichen Planus than whether it is curable and what are the complications in comparison to Leukoplakia.

Answered by Dr. Gunjan Gupta (1 hour later)

Hi XXXXXXX

Thanks for writing in.

White patches in the oral mucosa are commonly due to the following possibilities:
1. Oral lichen planus.
2. Canadidiasis.
3. Syphilis.
4. Leukoplakia.
5. Inflamatory reaction because of smoking.

I am glad that malignancy is ruled out by your dentist. However as your dentist diagnosed you as Lichen Planus, may I know if you had under gone any test to diagnose that. If ys, please let me know.

If I were to be your treating doctor, I would suggest you go to an oral surgeon/oral pathologist and ask for following-

1. Punch biopsy, for the confirmation or to rule out the the another causes.
2. Hepatitis-c test,a possible trigger of lichen planus.
3. Allergy test-to identify the agents that may act as triggers of your condition.

The above test should provide better clues to confirm the possibility.

Lichen planus may last from few months to several years and usually clear ups on its own. But treatment may be necessary to suppress itching and promote healing of the lesion.
Treatment of lichen planus can be according to triggers.

Please provide me complete detail of your tests and treatment.

Awaiting for your reply.

Dr. Gunjan Gupta

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Gunjan Gupta (2 hours later)

Thanks Sir,
As I mentioned earlier scrap from different white patches were collected and tested under Microscope (perhaps SCRAP CYTOLOGY) on 2nd Jan'2013. They reported that No Malignant Cell found. However, Mild Inflammation is there. The dentist looking at the shape, size and colour in his clinic named it as LICHEN PLANUS though my brother is at high risk of developing Leokoplakia. No further test like biopsy has been done. Treatment is going on with Triamcinolone Acetonide oral paste, Rebamipide and Vitamins tablets. Some old spots have disappeared by the same time one or two more patches have appeared at other location. My brother is quite nervous and tense in fear of oral cancer. Perhaps due to fear and anxiety he always complains on new complications though the Doctor denies it. Shall I insist the doctor to go for other test as suggested by you in your early reply to ensure whether it is Leukoplakia OR Lichen Planus or visual observation of the Dentist is sufficient for diagnoses of Lichen Planus.

Waiting for your valuable reply.

XXXXXXX

Answered by Dr. Gunjan Gupta (27 hours later)

Hi XXXXXXX
Thanks for writing again.
As you provided the detail, your doctor has been diagnosed this lesion as LICHEN PLANUS after cytology test and he is taking treatment for the same, which is effective also, so i would like to suggest you follow your doctor properly.
XXXXXXX i treatment options for LICHEN PLANUS are following-

1. Corticosteroids.
2. Retinoids.
3. Non-steroidal creams and ointments.
4. Antihistamine.
5. Phototherapy.
6. Ultra violet rays-A& B.
7. Addressing triggers, like-hepatitis-c infection, allergens etc......

Following can help you to reduce inflammation and itching due to LICHEN PLANUS-

1.cool compresses.
2.tub soaks with colloidal oatmeal.

One more thing i would like to suggest you ,please ask your brother to leave smoking as soon as possible otherwise there will be more complications along with.

Hope this answered your query, if you have further any doubt, i will be happy to help you.
Take Care.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Gunjan Gupta (1 hour later)

Madam,

Thanks a lot. Only one question since my brother came to know from an article available in website that there is NO CURE to Lichen Planus. Again it may lead to oral cancer in future. So he is quite nervous and in anxity. Please Madam tell me how shall I help him to come out from this stressful situation.

Awaitng for your valuable reply.

Answered by Dr. Gunjan Gupta (10 hours later)

Hi XXXXXXX

Thanks for your follow up query again.
XXXXXXX as I mentioned earlier LICHEN PLANUS may lasts few months to few years and clear ups on its own because LICHEN PLANUS is an autoimmune disorder.

Treatment of LICHEN PLANUS is necessary to suppress itching and to promote healing of the lesion only.

One more thing XXXXXXX if your brother will not quit smoking, he will be on the great risk of leucoplakia/oral cancer.

So please ask him to quit smoking as soon as possible.

Hope this answered your query, if you have further any doubt, feel free to ask.
Take Care.
Dr.Gunjan Gupta

Note: Find out which dental treatment will work best for your teeth. Ask here.

Above answer was peer-reviewed by : Dr. Shanthi.E