Across Tongues and Territories: Mapping Oral Lichen Planus in India s Diverse Landscape of Care

Research Article

J Dent & Oral Disord. 2025; 11(2): 1193.

Across Tongues and Territories: Mapping Oral Lichen Planus in India’s Diverse Landscape of Care

Mukherjee N and Das A*

Housesurgeon, North Bengal Dental college and Hospital, West Bengal, India

*Corresponding author: Das A, Housesurgeon, North Bengal Dental college and Hospital, West Bengal, India Email: annesha0210@gmail.com

Received: August 04, 2025 Accepted: August 25, 2025 Published: August 26, 2025

Abstract

Background: Oral Lichen Planus is a chronic autoimmune mucocutaneous potentially malignant disorder with a significant female predominance. The higher prevalence of Oral Lichen Planus among peri and post-menopausal women suggests that declining estrogen levels may play a key role in immune dysregulation and mucosal integrity. Additionally, women with Oral Lichen Planus frequently present with hypertension and impaired glucose tolerance, especially in their late 40s and 50s, these findings align with the broader concept of Grinspan’s Syndrome.

Objective: To systematically analyze clinical patterns, systemic comorbidities, therapeutic response in Oral Lichen Planus over the past decade.

Methodology: This study was conducted as a narrative literature review with elements of a systematic approach aimed at analyzing trends, advancements and regional variations in the treatment of Oral Lichen Planus (OLP) in the women over the last two decades (2007 to 2025). The primary objective was to critically evaluate the therapeutic strategies used, with a focus on North and South India and identify evidence based gaps and gender specific patterns.

Important Mention: Ethical Considerations

As this study involved secondary analysis of previously published data, no ethical approval or patient consent was required. However, only peer reviewed and ethically approved research studies were included to maintain academic integrity.

Introduction

Oral Lichen Planus is a chronic T -cell mediated mucocutaneous disorder that predominantly affects the oral cavity [1-6] and is notably more prevalent in females, particularly in the 30-60 age group. Characterized by a range of clinical presentation from asymptomatic reticular patterns to painful erosive and ulcerative lesions – Oral Lichen Planus not only impact oral function and quality of life but also carries a small yet significant risk of malignant transformation. Its pathogenesis multifactorial, involving T- cell mediated autoimmune responses, hormonal imbalances, stress and genetic predisposition – factors which disproportionately affect women [7-15].

In India a country marked by vast cultural, dietary, socioeconomic, and healthcare disparities, clinical profile and management of Oral Lichen Planus vary slightly across regions. Women in North India often presents with more symptomatic lesions, possibly due to higher tobacco use, psychological stress and delayed healthcare access. In contrast South India demonstrates relatively earlier diagnosis, better treatment adherence, and wider use of alternative therapies such as Ayurvedic or herbal interventions, possibly influenced by stronger public health outreach and cultural receptivity to integrative medicine.

While topical corticosteroids remain the mainstay of Oral Lichen Planus therapy across India, emerging modalities – such as calcineurin inhibitors, low level laser therapy, biologics and herbal extracts like curcumin and aloe vera are being increasing explored in urban and tertiary care centers and access to these treatment and adherence to long term management vary widely in different regions.

This paper presents a comprehensive comparative analysis of Oral Lichen Planus in women across different parts of India, with particular emphasis on epidemiological patterns, clinical manifestations and evolving treatment modalities, The goal is to highlight region specific challenges and propose context sensitive, gender responsive strategies for more effective and equitable management of oral lichen planus in women [16-21].

Comparative Studies of Oral Lichen Planus in North India, South India and West Bengal

Table 1, Figure 1.

Figure 1: Graphical Representation of South India V/S North India OLP Sites.

    

    
    

    

    Figure 1: Graphical Representation of South India V/S North India OLP
Sites.

Table 1: Comparative studies of oral lichen planus in North India, South India and West Bengal.

    

    
    

    

    Table 1: Comparative studies of oral lichen planus in North India, South India and West Bengal.

Treatment Protocol

According to 2025 study on Pharmacological Treatment of Oral Lichen Planus [1].

1st line of treatment:

Table 2, Figure 2.

Figure 2: North India V/S South India Predilection of OLP.

    

    
    

    

    Figure 2: North India V/S South India Predilection of OLP.

Table 2: 1st line of treatment.

    

    
    

    

    Table 2: 1st line of treatment.

Mechanism of Action: (Raghavendra Kini et al study) [19]

EXUDATION OF LEUCOCYTES AND PLASMA CONSTITUENTS

DECREASE IN EDEMA AND MAINTAINENCE OF CELLULAR MEMBRANE INTEGRITY

INHIBITION OF LYSOZYME RELEASE FROM GRANULOCYTES, INHIBITION OF PHAGOCYTOSIS

STABILIZATION OF THE MEMBRANE OF THE INTRACELLULAR LYSOZYMES, WHICH CONTAIN HYDROLYTIC ENZYMES CAPABLE OF CELL DIGESTION AND EXTENSION OF INFLAMMATORY TISSUE DAMAGE

PROLIFERATION OF FIBROBLAST WITH DECREASE IN FIBROSIS

Mechanism of Action of Retinoids:

Antikeratinizing and immunomodulator effects (Table 3, Figure 3).

Figure 3: North India V/S South India OLP Variant.

    

    
    

    

    Figure 3: North India V/S South India OLP Variant.

Table 3: Antikeratinizing and immunomodulator effects.

    

    
    

    

    Table 3: Antikeratinizing and immunomodulator effects.

NOTE

1. Corticosteroids remain the standard of care,

2. calcinurin inhibitors like tacrolimus and less commonly cyclosporin are used in refractory cases,

3. Adjuntive therapy like Multivitamins, antioxidants, iron are used.

2nd Line of Treatment: [1]

Table 4, Figure 4.

Figure 4: South India Comorbidity V/S North India Comorbidity of OLP.

    

    
    

    

    Figure 4: South India Comorbidity V/S North India Comorbidity of OLP.

Table 4: 2nd Line of Treatment.

    

    
    

    

    Table 4: 2nd Line of Treatment.

Mechanism of Action of Calceurin Inhibitors

A Calcineurin inhibitor, suppressing the synthesis of pro – inflammatory cytokines and inhibiting the formation of active T cells.

3rd Line of Treatment: [1]

Table 5.

Table 5: 3rd Line of Treatment.

    

    
    

    

    Table 5: 3rd Line of Treatment.

Conclusion

From North India to South India and the cultural corridors of Bengal, Oral Lichen planus whispers a story of pain that knows no boundaries. The challenge now is to bridge these gaps – not just with medicine but with awareness, access, proper treatment protocol with empathy. Following observations are drawn below

• Oral Lichen Planus in women is a multifactorial condition shaped by hormonal vascular and metabolic factors

• Grinspan syndrome may represent a broader spectrum where ever borderline systemic changes deserve clinical attention.

• Multidisciplinary care and regular follow up all critical to prevent complications including malignant transformations.

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