The inside of your mouth hurts like crazy, so you stand in front of a mirror and open wide. Do you see white, lacy, raised patches… red, swollen, tender spots… and/or open sores? If so, you may have oral lichen planus (LIE-kun PLAY-nus), an inflammatory disease that affects more women than men and often arises in middle age. Lesions usually appear on the inside of the cheeks but also may develop on the tongue, gums, inner lips and throat. The disorder causes burning pain… a metallic taste in the mouth… sensitivity to spicy foods… dry mouth… and/or bleeding gums.
Oral lichen planus is not contagious. It occurs when the immune system attacks the cells of the mucous membranes in the mouth. The exact reason for this attack is unknown, but outbreaks can be triggered by allergies (for instance, to a food or dental product)… a viral infection (such as hepatitis C)… certain vaccines and medications (including nonsteroidal anti-inflammatory drugs)… or stress.
When outbreaks are linked to an allergy or drug, identifying and avoiding the offending substance can resolve the problem. However, in many cases, oral lichen planus is a chronic condition in which flare-ups continue to come and go indefinitely, with lesions lasting for days, weeks or even months. Since there is no known cure, treatment focuses on alleviating discomfort and promoting the healing of lesions. Problem: Steroid medication helps, but has potentially serious side effects. Topical steroids can lead to thrush (a fungal infection of the mouth) and suppress adrenal gland function, while oral and injected steroids increase the risk for osteoporosis, diabetes, high blood pressure and high cholesterol. And once steroid treatment is halted, lesions may return.
Intriguing alternative: Herbs. After reading about these in a recent issue of Alternative and Complementary Therapies, I contacted the article’s author, Eric Yarnell, ND, an associate professor in the department of botanical medicine at Bastyr University. While the herbs below have not been proven to cure oral lichen planus, they can ease discomfort… and some patients who use herbal treatments experience quick resolution of symptoms and remain free of recurrences for long periods of time, Dr. Yarnell said.
Important: Certain herbs can have side effects, so work with a health-care provider knowledgeable about herbal medicines, such as a naturopathic doctor, who can devise a safe and effective protocol for you and determine appropriate dosages. Dr. Yarnell generally prescribes a swish-and-swallow approach (taking a mouthful of a diluted herbal extract and swishing it in the mouth before swallowing it) so the herb acts topically as well as systemically—your own practitioner can advise you on this. Typically, Dr. Yarnell has his oral lichen planus patients use one or more of the following herbs, depending on the specific symptom (or symptoms) that bothers them most.Ask your health-care provider about using the following…
For pain—aloe vera (Aloe barbadensis). The gel found inside the leaves of the aloe plant contain complex carbohydrates, includingglucomannan, that soothe painful tissues and modulate the immune response.
For inflammation—turmeric (Curcuma longa). This spice contains substances called curcuminoids that reduce inflammation via multiple pathways. It doesn’t dissolve well in water, so Dr. Yarnell has patients dissolve turmeric in soymilk, nut milk or animal milk. Caution: People who are prone to kidney stones should not use turmeric (which is high in oxalic acid)—for them, curcumin extract is better.
For easily irritated tissues—tormentil (Potentilla tormentilla). Used in the form of a tincture (a medicinal extract in a solution of alcohol), this herbal preparation coats lesions, protecting them from irritation by food or compounds in saliva, Dr. Yarnell said. This remedy should not be used within 30 minutes of taking any other medications, as the herb may block absorption of other drugs. Caution: People who want to avoid alcohol should not use tormentil tincture.
For stress—licorice root (Glycyrrhiza glabra) or deglycyrrhizinated licorice (DGL). This is an adaptogen that helps patients handle the anxiety and stress that can contribute to oral lichen planus… it also modulates the immune system. It often is used in tincture form, though patients who want to avoid alcohol should use chewable DGL tablets instead. Caution:Licorice root remedies should not be used by patients who have uncontrolled hypertension or who are taking corticosteroids or other drugs that can deplete potassium, Dr. Yarnell said.
Note: Oral lichen planus may increase the risk for oral cancers, so it is important for patients to get regular oral cancer screenings from a doctor or dentist.