The Risk of Lichen Planopilaris in Patients with Oral Lichen Planus

What is my risk of lichen planopilaris if I have oral lichen planus?

I’ve selected this question below for this week’s question of the week. It allows us to review some concepts in oral lichen planus.

Question

I have oral lichen planus and I’m wondering what my risk of LPP is. Am I likely to develop LPP in the future? I’m feeling terrified about the whole thing actually.

Answer

Thanks for the question.

The short answer is that you probably won’t develop lichen planopilaris. The risk is not zero that you’ll develop LPP - but it’s really really low. Actually, it’s really really really low. I hope you get the point.

Oral lichen planus is a condition that develops in the 30s and 40s. Women are slightly more affected than males. F:M ratio of 1.4 to 1. Oral lichen planus affects about 1-2 % of the population. There are many different forms of oral lichan planus inlcuding variants such as the reticular, papular, plaque-like, erosive, atrophic, and bullous variants. The inner sides of the cheeks (buccal mucosa), tongue and gums are the most commonly affected.

In contrast, lichen planopilaris affects about 0.03% fo the population or roughly 1 in every 3000 to 5000 people. Most people with oral lichen planus don’t have lichen planopilaris at the time they are diagnosed with oral lichen planus and most never go on to develop it! So if you forced me to bet, I would bet you will not develop lichen planopilaris. The odds are dramatically stacked in my favour.

Most people with oral lichen planus never develop LPP. On the contrary, the risk of a person diagnosed with lichen planopilaris developing oral lichen planus is probably 1-2 %. This number is probably similar to the general population risk of 1-2 % or possibly a very slight amount higher. Good studies have not been done to really convincingly know if patients with LPP have a higher risk of oral lichen planus than the general population or not. It’s possible they do but large studies that generate good data just haven’t been done.