WARNING!

WARNING! THIS SITE HAS PICTURES AND CONTENT OF A MEDICAL NATURE AND MAY NOT BE SUITABLE FOR EVERYONE. VIEW AT YOUR OWN DISCRETION.

Friday, July 30, 2010

Lichen Planus Trigger

Many articles and discussion about Lichen Planus revolve around the suggestion that it is triggered by stress. (not caused by stress). Needless to say, the following books might be considered helpful in understanding and reducing stress.

It's up to you to decide if these will help you.

What Happy People Know
By Baker, D. and Stauth, C.
 
What should I do with my life?
By Bronson P.
 
Don't Sweat The Small Stuff
By Carlson, R.
 
The Power of Full Engagement
Loehe, J and Schwartz T.
 
The Power of Optimism
McGinnis A L.
 
The Lost Art of Listening
Nichols, M.
  
Learned Optimism
Seligman M.E.P.
 
Half empty-Half Full
Vaughn, S.

I, personally do not believe Lichen Planus is triggered by stress. There are so many kinds of stress, how would one pinpoint it? On the other hand, I cannot help but notice how deeply stressed out I feel when my mouth is burning and raw open sores proliferate. Yes, that is very stressful indeed!

Sunday, July 25, 2010

Annular Lichen Planus

Annular lichen planus is a rare form of lesions which has a ring-like appearance. This has shown up in about 10 % of cases. But, they show up accompanied by the standard appearing  Annular LP usually has no symptoms.

You can go to Dermatolgy Online Journal for further information

Sunday, July 18, 2010

Actinic Lichen Planus

"Actinic lichen planus: Subtropic or actinic lichen planus occurs in regions, such as Africa, the Middle East, and India. This mildly pruritic eruption usually spares the nails, the scalp, the mucous membranes, and covered areas. Lesions are characterized by nummular patches with a hypopigmented zone surrounding a hyperpigmented center." (From eMedicine site)

The word Pruitic means Itchy.

Mucus Membranes means the moist skin inside the mouth.

Lesions are areas of tissue damage.

Nummular patches means round patches.

Hypopigmented means without color, and hyperpigmented means with above average color. So the nummular patches may have on the outside a lack of coloring but on the inside a more obvious color appearance

Thursday, July 15, 2010

Coping with OLP

One of the questions I was recently asked was how do I cope with my Oral Lichen Planus.

I don't feel that I cope all that well, as it is so frustrating not to be able to rely on your body to be okay. But, what else can I do, but live with it as best I can. And sometimes it is not always "best". If I get upset about something, angry, or crying, it definitely makes everything more noticeable. I don't know that it makes it worse as some will suggest, but I do know that I am more aware of the intensity of the pain. Plus, using the muscles in the neck, mouth area in extreme certainly puts pressure on an already very tender and vulnerable mouth!

Many articles on OLP say nothing about the debilitating effect it has on the psyche. As a patient visiting various dermatologists, dentists, and even an ear nose throat specialist, I often got the impression that they had seen much more serious conditions and my problem didn't seem all that important to them.

When I say that I really feel sick, run down, when I have a flare up or worsening of my condition, it is not believed because it is not listed as a typical symptom in the medical literature. "Average" medical cases of OLP are considered minor and usually easily treatable. So, when a someone comes along and doesn't fit the mold, I'm sure it is hard for the doctor to believe the patient.

So I have had to cope with trying to find a doctor who not only knows about Oral Lichen Planus, but cares that I suffer, and is willing to try different medications to ease my pain. And most of all, will listen and attempt to believe me. And I have to do my part to communicate effectively without whining, and giving the facts as succinctly as possible of what I am experiencing.

I have had to cope by finding other ways to relieve my pain as well. Taking regular pain meds such as Tylenol (acetaminophen) actually helps. Using Aspercreme on the skin outside, on my neck or partially on my face seems to help. I find that I cannot always relieve the pain entirely with these methods, but some is better than none.



I've had to accept that I cannot just eat whatever else other people eat. I've had to experiment. Sometimes I can eat Macaroni and cheese, or pudding, or soup. Other times I can have a more varied diet.

I've had to really open up and explain to family and friends what is going on, that it is NOT contagious, that it is NOT herpes, that I appreciate all their suggestions for remedies and nutritional changes, and I will take them into consideration. Then, if they are so interested as to offer medical advice like that, then I offer to show them my mouth in detail.

I've learned that it is essential that I know as much as I can about Oral Lichen Planus so that I can speak intelligently about it. And sometimes defensively in regards to those who think it might be caused by walking barefoot on cold floors or looking at the moon when it is full, or eating too much of a certain food, or not enough or whatever. If I have enough knowledge about the scientific facts, I'm not going to be led astray from the best possible chance for good care (and hopefully, remission).


I've learned to cope when things are really bad, by not speaking, leading a quiet life, staying to myself. If my mouth is very painful, the sores are bad and the tongue is swollen, just the act of talking aggravates things.

I let the phone message machine answer for me.

I email or text instead of calling someone.

I ask someone else (friend or family) to call if I have some business to take care of that can't wait.

I know this might not be entirely useful information for those who lead a busy life, work for a living, and have children. I'm retired, on disability and my kids are grown up and don't live nearby. So, I can "retreat" when I want to.

I often wonder how others cope with the various aspects of their OLP, especially if there's children to take care of, or a job to maintain, or other large responsibilities.

Buccal Striations

Lifestyle and Oral Lichen Planus

Due to two recent comments, I will post an update answering some specific questions posed

If you have read through previous postings, you will know that I have been dealing with an unrelenting case of Oral Lichen Planus. There are different degrees of the condition, everything from some lacy white designs on the inside of the cheeks to downright raw openings on the tongue, gums cheeks, throat, and occasionally the esophagus and lips. When the condition is this raw, like open sores, it is called Erosive Oral Lichen Planus. For some patients who have this, it can ebb and flow. There will be time periods where it will seem to disappear. Because of this, sometimes people think they are cured and occasionally attribute the new healthy looking mouth to whatever they were using to treat it.

For some patients OLP can be in remission for very long periods of time. I hope you, the reader, are in that category. Please don't think that what has happened to me will automatically happen to you.

I have not been so fortunate. One could question if I live a lifestyle of poor choices and suggest that is what contributes to my chronic OLP. So, for the record:

I don't drink alcohol.
I don't drink coffee.
I don't drink soda.
I don't smoke.
I don't partake or recreational drugs.
I don't eat spicy food.
I don't eat anything with cinnamon in it.
I don't eat anything with mint in it.

Note: It is challenging where the last two ingredients are concerned because so many things can contain them. Cinnamon and mint are supposed to be notorious for aggravating OLP, according to my oral medicine clinic doctors. And of course, I'm sure anyone reading this who had the diagnosis of OLP probably already knows spicy food doesn't help it. Even some of the mouth cleansing products that are supposed to be for people with mouth problems have mint in them!!!

From my own personal experiences, I have noticed that dry crunchy foods, such as chips, crackers, sometimes crackers, etc, aggravate my mouth. I couldn't understand it at first. Then it dawned on me one day when my mouth was doing really well. I was eating some tortilla chips. They are not a soft substance. In fact, they are very much like chomping on shards of glass! No wonder my mouth would be sore the next day.

I don't think that the original cause of OLP has anything to do with eating sharp edged food. I just think that when someone has a mouth that has been so much under attack, it is fragile and cannot handle food in the same way as other people can.

The picture below represents the lacy appearance of Oral Lichen Planus.

Wednesday, July 14, 2010

TYPES OF LICHEN PLANUS

CLINICAL TYPES OF LICHEN PLANUS:

1) Actinic

2) Annulare

3) Bullous

4) Classic

5) Erythematosus

6) Exfoliative

7) Familial

8) Guttate

9) Hypertrophic

10) "Invisible"

11) Lineal

12) Muco-membranous (genital, esophagus)

13) Nail

14) Oral

15) Penphigoides

16) Perforating

17) Pigmentosus

18) Planopilaris

19) Ulcerative

20) Zosteriform

Oral Lichen Planus has 6 types: Reticulated, Atrophic, Papular, Plaquelike, Erosive and Bullous

Saturday, July 10, 2010

Response of Oral Lichen Planus to Topical Tacrolimus

I have had topical Tacrolimus as part of my treatment. Though it was somewhat effective for me, it never eradicated my lesions, and therefore was unsatisfactory. Going without eating a nutritious diet because of my mouth sores was reason enough to keep trying other medications.



Though, it is well known that Tacrolimus is very helpful for some patients, perhaps it is because they do not have such a severe case as I have had. Mine was called Erosive Oral Lichen Planus, because the sores were so big on my tongue in particular.

You might find the following article useful and informative.

Response of Oral Lichen Planus to Topical Tacrolimus

Wednesday, July 7, 2010

OLP is Chronic and Uncurable

Since the average age at onset of Oral Lichen Planus is documented to be 55 years, and it affects women more than men, it makes me wonder if male hormones would be helpful to quell the disease. This is entirely speculation on my part.

Of all the treatments I have been given over the years Corticosteroids were the most effective but not enough to keep the OLP at bay unless I continued to take it for long periods of time.

This full PDF article on research done at University of San Francisco is very informative.

Even if you don't live near San Francisco, perhaps sharing the article with your Dentist will give him or her the opportunity to make contact for further information.

Presently, with Cellcept as my main treatment, my mouth looks like this and has minimal pain.

Saturday, July 3, 2010

Keeping a Clean Mouth

I like to research Oral Lichen Planus in Pubmed. I found a recently published abstract done by researchers in Spain. The idea of the study was to determine if patients were given a program encouraging them to get better plaque control. That means brushing their teeth regularly and flossing.

I can understand why they created this study. The better your plaque control, the healthier condition the gingiva will be. The problem is that most people with oral lichen planus, especially those with involvement of the gingiva, find it challenging to even want to brush their teeth and floss.

I have to admit I am the same way. It's painful! It's inflicting pain on top of pain to brush teeth and floss! If your Oral Lichen Planus involves the gingiva, you probably already know. But, for the benefit of those who don't, gingiva is the flesh closest to the teeth, the gums.


They had 40 patients with gingival lichen planus and introduced them to a motivation-behavioral skills program. I'm guessing this means that they were educated in the necessity, encouraged to brush and floss over and over again until the patients really got involved with following through with taking better care of their mouths. It would be the same idea, I think, of teaching a child in the same behavior. This was done over a period of 4 and 8 weeks.

The result was that the patients had significant improvements in the quality of mouth health. Of course, it was recommended that more studies like this one be done to see if the program would have the same results.

At the Oral Medicine Clinic I go to at the University of San Francisco, I am always encouraged to do the same. Plus, I am to have my teeth cleaned by a Dental Hygienist every four months.

Reference:

J Periodontol
2010 Jun 23
Application of a Motivation-Behavioral Skills Protocol in Gingival Lichenplanus: A Short-Term Study.

López-Jornet P
Camacho-Alonso F.

Department of Oral Medicine
Murcia University Dental School
Murcia, Spain

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The picture is from the Endo Blog


Always seek the advice and supervision of a qualified licensed medical professional!

The information provided on this site has been created as an online journal only. The author is writing from her personal viewpoint and cannot guarantee the completeness or accuracy of the information displayed.

Comments to any of the entries are appreciated.