Oral Lichen Planus

Written by Kristin Mitchell
Medically Reviewed by Robert Brennan, DDS on March 11, 2025
6 min read

Oral lichen planus is a long-lasting disease that affects your mouth, causing symptoms such as painful white patches, redness, and swelling. It doesn't go away, but you may need medications to control your symptoms. 

Oral lichen planus isn't contagious, but anybody can get it. Women are twice as likely to have it than men, and it's most common in people older than 50. But kids and young adults can also get it.

Oral lichen planus vs. leukoplakia

Both oral lichen planus and leukoplakia affect the tissue lining of your mouth (mucosa), and their symptoms appear on your gums, inside your cheeks, or your tongue. However, the two conditions differ in many ways.

With oral lichen planus, the tissue lining of your mouth can become white and thread-like, or your gums can become bright red. Symptoms most commonly appear on the inside of your cheeks. If you have leukoplakia, you may get white sores or patches on your gums, as well as on the bottom of your mouth and inside your cheeks. Your tongue may also appear white.

The possible causes of the two conditions are also different. Although the actual cause is unknown, oral lichen planus may come from autoimmune diseases, while leukoplakia can come from using tobacco products, heavy smoking, or drinking alcohol.

Also, leukoplakia is more likely than oral lichen planus to develop into oral cancer.

Doctors aren't sure what causes oral lichen planus, but several things could play a part:

  • Genetics. The condition may run in your family.
  • Your immune system. Most of the time, your immune cells keep you safe by attacking bacteria and viruses. With oral lichen planus, some doctors believe, your T-cells get confused and attack the lining of your mouth.
  • Hepatitis C. Many people infected with this virus get it.

 

Some things can set off the condition for the first time or worsen it if you already have the condition. These include:

What is certain is that you can't pass it to anyone else and you didn't catch it from someone; oral lichen planus isn't contagious.

Symptoms can come on slowly or start all at once. 

SIgns of lichen planus in mouth

You can get lichen planus anywhere on your body that has mucosa. But if it happens in your mouth, it's oral lichen planus.

Your symptoms may begin with:

  • Dryness
  • A metallic, burning taste in your mouth

Then you may see:

  • White patches on your tongue, cheeks, and gums, which can appear as tiny dots or lines forming a lace-like pattern
  • Redness and swelling
  • Peeling or blistering

These sores may burn and be painful. They'll likely hurt the most when you eat or drink foods that are spicy, salty, acidic (orange juice, tomatoes), or alcoholic. Crispy treats and drinks with caffeine can also cause problems.

Your doctor can diagnose oral lichen planus by doing a biopsy, where a small piece of skin is taken from inside your mouth. They’ll run tests on it in the lab to see what the problem is. You may also need blood tests to rule out other conditions.

 

Oral lichen planus is a chronic condition, meaning it does not go away. If you have a milder form of the condition, you may not need treatment. However, if you do have symptoms, your doctor can help you manage them.

If you feel only a slight roughness in your mouth, you may not need treatment. If you’re in pain or have sores, your doctor may suggest a corticosteroid cream or ointment, pill, or injection. In rare cases, they might prescribe steroid pills.

If your doctor believes your immune system is causing your symptoms, they may suggest a medication that turns down its normal response. These include:

Topical ointment or gel. Your doctor may prescribe a topical steroid paste or ointment that can be applied directly to your mouth after a meal. Medications that are commonly prescribed for oral lichen planus include: 

  • Cyclosporine
  • Dapsone
  • Lidocaine
  • Pimecrolimus (Elidel)
  • Tacrolimus (Protopic)

 Some immune response medications come with an FDA warning due to an unknown link to cancer. Talk to your doctor about any medication risks.

Systemic medications. For more severe cases, your doctor may recommend systemic medications that you would take by mouth. Your doctor may prescribe them if you’re dealing with oral lichen planus in other parts of your body such as your scalp, genitals, or esophagus.

Watch what you eat and drink. Certain foods and drinks, especially spicy or citrus ones, can worsen your symptoms. Hot or cold foods and drinks can also make you more uncomfortable.

Stress can also make things worse.

Get rid of any problems that could trigger or worsen oral lichen planus:

  • Have your dentist polish sharp teeth or replace damaged fillings or crowns.
  • Talk to your doctor about changing medications that may be to blame.
  • Brush twice a day, and floss daily.
  • See your dentist twice a year for cleaning and checkups.
  • Use a mild toothpaste and a soft toothbrush.

You also need to keep track of your symptoms and tell your doctor about any changes in your mouth. There's a slight chance that oral lichen planus can lead to oral cancer. Make sure to get a screening for oral cancer every 6 to 12 months.

It's also important to enjoy a diet rich in fruit and vegetables and avoid spicy or acidic foods that may worsen your symptoms. If you smoke, quit. Don't drink large amounts of caffeine or alcohol. Learning to manage your stress and avoiding habits such as chewing the inside of your cheek can also help with prevention. See your doctor regularly to look for any changes in your mouth.

Oral lichen planus is a chronic condition that causes white string-like patches inside your mouth, including your tongue, inner lip tissue, gums, and inner cheek area. It can be mild for some, while for others, it can be more severe and may affect areas outside the mouth. Proper hygiene and managing stress can help prevent the condition and flare-ups. Your doctor can also prescribe medications that can help ease your symptoms.

What does lichen planus on the tongue look like?

If you have lichen planus, a white coating may form on your tongue.

Is oral lichen planus dangerous​?

No, oral lichen planus isn't considered dangerous; however, it is a lifelong condition that may come with flare-ups in more severe cases.

Does oral lichen planus go away?

No, it's a chronic condition, which means it won't go away but your symptoms are treatable.

Is oral lichen planus contagious?

No, oral lichen planus isn't contagious. It can be caused by genetics and autoimmune diseases, but the exact cause is unknown.