E-ISSN :0975-8437 P-ISSN: 2231-2285
CASE REPORT
Childhood oral lichen planus: a case report
Vinay Kumar Reddy, Sri Sai Ramya, Kotya Naik Maloth, K Sunitha
ABSTRACT
Oral lichen planus is a chronic inflammatory immune-mediated disease. The etiology of oral lichen planus is not fully
understood. It is common in the fifth to sixth decades of life, and rare in children. This paper reports a case of oral lichen
planus affecting a 13-year-old child without cutaneous lesions.
Keywords: Autoimmune disorder ; Graft-versus-host disease; Lichen planus
Introduction
Oral lichen planus (OLP) is a common chronic immunolog-
ic inflammatory mucocutaneous disorder.1 Eventhough the
etiology of oral lichen planus is not fully understood, the au-
to-cytotoxic CD8+ T-cells play an important role by triggering
apoptosis of the basal cells of the oral epithelium.2,3 The clinical
presentation of OLP ranges from mild painless white keratotic
lesions to painful erosions and ulcerations.4-7 About 28% of pa-
tients who have OLP have skin lesions.8,9 OLP affects primarily
middle aged adults and is rare in children.10 It affects 1 to 2 %
of the general adult population, the reported prevalence of
OLP in childhood is 0.03%11,12 and in the Indian population is
2.6%.6 OLP has been reported be more frequent in females5
and occurs more predominantly in Asians.13 This paper reports
a case of oral lichen planus affecting a 13-year-old child with-
out cutaneous lesions.
Case Report
A 13-year-old boy reported to the department of oral medi-
cine and radiology with a chief complaint of burning sensa-
tion in the mouth for last one month. Medical history reveals
that he had seizures ten years back and was under medica-
tion for two years. His family history was noncontributory
and there was no history of drug intake for last eight years.
On extra-oral examination no cutaneous lesions were pres-
ent. On intra-oral examination erythematous gingival lesions
were seen involving marginal and attached gingiva of all the
teeth, more severely involving the right side (Figure 1). Diffuse
erythematous areas surrounded by white striae were seen in
relation to both right and left buccal mucosa (Figure 2,3). The
lesions were non-scrapable. The patient had no caries or amal-
gam restorations. An incisional biopsy was performed and
histopathological examination shows (Figure 4,5) atrophic
stratified squamous hyper parakeratinized epithelium with
few areas of discontinuity, indicating erosion with liquefac-
tive degeneration of basal cell layer. There is a sharply defined,
dense, band-like infiltrate predominantly of lymphocytes hug-
ging the basement membrane. The connective tissue showed
perivascular inflammatory cells, suggestive of Atrophic Lichen
Planus. The patient was motivated for maintaining proper oral
hygiene and was prescribed 0.1% triamcinolone acetonide
ointment 2 to 3 times a day.
Discussion
OLP is classified into reticular, erosive, atrophic, bullous and
pigmented types.6,7,14-16 The reticular form is the most com-
mon type of OLP followed by erosive OLP.17,18 Atrophic OLP
I N T E R N AT I O N A L J O U R N A L O F D E N TA L C L I N I C S
Figure 1. Desquamative gingivitis involving the marginal and at-
tached gingiva on the right side, Figure 2. Diffuse erythematous areas
surrounded by white striae seen on the right buccal mucosa, Figure 3.
Diffuse erythematous areas surrounded by white striae seen on the
left buccal mucosa, Figure 4. Histopathological picture 10x view, Fig-
ure 5. Histopathological picture 40x view
appears as diffuse, erythematous patches surrounded by fine
white striae.18 This form can cause significant discomfort. The
reported prevalence of OLP in childhood is significantly low-
er than that in adults.11,19 The difference in prevalence rates
has been partially attributed to the low number of associat-
ed systemic diseases, autoimmune phenomenon, drugs, and
dental restorations in childhood.5,11 In our case the gingi-
val involvement was more evident due to mild to moderate
amount of plaque accumulation. Moreover, exacerbation of
symptoms in our patient may be related to intake of spicy
foods. Children affected with OLP are often asymptomatic or
minimally symptomatic.1,3,11,20 Our case can be considered rare
and unique owing to its age of occurrence and involvement
of gingiva, which has been reported to be less common. The
differential diagnosis of erosive OLP includes squamous cell
carcinoma, discoid lupus erythematous, chronic candidiasis,
benign mucous membrane pemphigoid, pemphigus vulgar-
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is, chronic cheek chewing, lichenoid reaction to dental amal-
2014 Volume 6 Issue 3
gam or drugs, graft-versus-host disease (GVHD), hypersensi-
tivity mucositis and erythema multiforme.18,21-23 Excellent oral
hygiene is believed to reduce the severity of the symptoms,
but it can be difficult for patients to achieve high levels of hy-
giene during periods of active disease.18,24 Treatment is aimed
primarily at reducing the length and severity of symptomatic
outbreaks. Topical corticosteroids are the mainstay in treating
mild to moderately symptomatic lesions.18,22,24,25 Other docu-
mented treatment modalities include retinoids and vitamin-A
analogues, cyclosporine rinse, the immunomodulating agent
levamisole, dapsone, griseofulvin, azathioprine and cryother-
apy.26,27
Conclusion
In conclusion, it is important to consider lichen planus as one
of the differential diagnosis for hyperkeratotic and erosive le-
sion of the oral mucosa in children.
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E-ISSN :0975-8437 P-ISSN: 2231-2285
Reddy et al
Authors Affiliations
1. Vinay Kumar Reddy, MDS, Professor and Head, Department of Oral
Medicine and Radiology, Mamata Dental College and Hospital, Kham-
mam, Telangana, India, 2. Sri Sai Ramya, MDS, Post Graduate Student,
Department of Oral Medicine and Radiology, Mamata Dental College
and Hospital, Khammam, Telangana, India, 3. Kotya Naik Maloth,
MDS, Senior Lecturer, Department of Oral Medicine and Radiology,
Mamata Dental College and Hospital, Khammam, Telangana, India,
4. K Sunitha, MDS, Senior Lecturer, Department of Oral Medicine and
Radiology, Mamata Dental College and Hospital, Khammam, Telan-
gana, India.
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How cite this article
Reddy VK, Ramya SS, Maloth KN, Sunitha K. Childhood Oral Lichen
Planus: A Case Report. International Journal of Dental Clinics.
2014;6(3):25-26.
Address for Correspondence
Dr. Kotya Naik Maloth, MDS,
Senior Lecturer,
Department of Oral Medicine and Radiology,
Mamata Dental College and Hospital, Giriprasad nagar,
Khammam, Telangana, India.
Email: dr.kotyanaik.maloth@gmail.com
Source of Support: Nil
Conflict of Interest: None Declared