Lichen planus is a chronic inflammatory disease of the skin and mucous membranes, and is one of the common diseases of the oral mucosa. The exact cause of the disease remains unclear. It may be related to factors such as infection, mental state, endocrine disorders, systemic diseases, genetics, and immunity.

bubble_chart Clinical Manifestations

Lichen planus of the tongue accounts for approximately 44% of oral lesions. Lesions often occur in the anterior two-thirds of the tongue, including the tip, lateral borders, and ventral surface. Early dorsal tongue lesions appear as papules with a bluish-white hue, involving filiform papillae, gradually forming round or oval gray-white patches that feel rough to the touch. After papillae atrophy, the lesions become smooth, bright red, or dark red patches, which may erode. Dorsal tongue lesions may also present as a combination of hyperkeratosis with partial atrophy. If hyperkeratosis is prominent, the lesions can be easily confused with leukoplakia. Ventral tongue lesions often exhibit a reticular, dendritic, or striated pattern. Tip lesions are less common and may involve the lingual frenulum. Lesions on the ventral side of the lateral tongue with long-term congestion and ulceration should be monitored, and biopsy should be performed if necessary to rule out malignancy.

bubble_chart Treatment Measures

The treatment methods are as follows: ① Remove various harmful irritants, such as dental plaque, sharp teeth, and poor restorations. ② Maintain oral hygiene by gargling with 0.05% chlorhexidine solution. ③ For local inflammatory changes, apply corticosteroid ointment or membrane agents. For long-term non-healing erosions, inject 2–5ml of dexamethasone acetate solution mixed with an equal amount of 2% procaine, or 0.5–1.0ml of prednisolone acetate suspension (25mg/ml) at the base of the lesion. Inject once every 3–7 days, and inflammation can be resolved in 2–5 treatments. ④ Retinoic acid can be taken orally, but due to significant side effects, it is now mostly applied topically. The concentration of the paste is 0.1%–0.3%, applied locally once daily, and can be combined with hormone ointment. ⑤ For long-term non-healing localized isolated lesions, surgical excision, helium-neon laser irradiation, or liquid nitrogen cryotherapy can be performed.