Lichen planus is a chronic inflammatory disease of the skin and mucous membranes, and is one of the common conditions affecting the oral mucosa. The exact cause of the disease remains unclear, but it may be related to factors such as infections, psychological stress, endocrine disorders, systemic diseases, genetics, and immune responses.

bubble_chart Diagnosis

Lichen planus of the tongue accounts for approximately 44% of oral lesions. The lesions mostly occur in the anterior two-thirds of the tongue, including the tip, edges, and ventral surface. Early lesions on the dorsal tongue 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 papillary atrophy, they become bright red or dark red smooth patches, which may erode. Dorsal tongue lesions can also present as a combination of papillary hyperkeratosis and partial atrophy. If hyperkeratosis is prominent, the lesions may be easily confused with leukoplakia. Lesions on the ventral tongue often appear reticulated, dendritic, or striated. Lesions at the tongue tip are less common but may involve the lingual frenulum. For long-term congestive lesions with ulcers on the ventrolateral tongue edge, follow-up observation is necessary, and a biopsy should be performed if needed to rule out malignancy.

bubble_chart Treatment Measures

1. Remove various harmful stimuli, such as removing dental plaque, correcting sharp teeth, and eliminating poor restorations.
2. Maintain oral hygiene by rinsing with a 0.05% chlorhexidine solution.
3. For local inflammatory changes, corticosteroids ointment or membrane agents can be applied. For long-term unhealed erosions, a solution of 2–5ml dexamethasone acetate with an equal amount of 2% procaine, or a suspension of prednisolone acetate (25mg/ml) 0.5–1.0ml can be injected at the base of the lesion. Inject once every 3–7 days; inflammation can be resolved in 2–5 injections.
4. Tretinoin can be taken orally, but due to significant side effects, topical application is now more common. The concentration of the paste is 0.1%–0.3%, applied locally once daily, and can be combined with corticosteroid ointment.
5. For long-term unhealed localized isolated lesions, surgical excision, helium-neon laser irradiation, or liquid nitrogen cryotherapy may be used.