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Oral Lichen Planus: White Lacy Patches and Sore Areas in the Mouth

Oral lichen planus is a long-term inflammatory condition that causes white, lace-like patches and sometimes sore red areas inside the mouth. It is not infectious. Treatment eases symptoms, and regular dental checks matter.

Updated September 2026·By the OHA editorial team·7 min read·How we write
Key takeaways
  • Oral lichen planus is a long-term inflammatory condition of the lining of the mouth. It is not an infection, you cannot catch it or pass it on, and it does not usually run in families.
  • It usually shows as a white, lace-like pattern inside the cheeks or on the tongue. Some people also get red, sore areas or ulcers, and burning or stinging when they eat.
  • A dentist or doctor can often recognise it by looking, but a small tissue sample (biopsy) is often taken to confirm it.
  • There is no cure, but mild cases need no treatment, and steroid gels or rinses and other mouthwashes or sprays can ease soreness. Avoiding foods that sting and keeping your mouth clean help too.
  • There is a small increased risk of mouth cancer, so regular dental check-ups are important. See your dental team about any new patch, lasting soreness or change.

Lichen planus can affect the skin, nails, scalp, genitals and the inside of the mouth. In the mouth it is called oral lichen planus. DermNet, a skin health reference from New Zealand, describes lichen planus as a chronic (long-lasting) inflammatory condition.

Leaflets from Cambridge University Hospitals and Hull University Teaching Hospitals say it affects up to 2 in every 100 people. DermNet says it usually affects adults over 45, and NHS inform (Scotland) says oral lichen planus is more common in women.

What does oral lichen planus look like?

The Oral Health Foundation says the most common sign is white patches, often inside the cheeks, and sometimes on the tongue and gums. The Cambridge leaflet describes a lace-like pattern of streaky white patches, often symmetrical (the same on both sides of the mouth).

DermNet describes three forms, which often appear together:

  • Reticular: a white, lace-like pattern inside the cheeks, with no symptoms or some soreness.
  • Erosive: red areas, often with a whitish border, which may form shallow ulcers. It most often affects the gums and lips and can be very painful.
  • Plaque type: white patches that join together, usually seen in smokers.

University Hospitals Plymouth says affected gums can become red and shiny (desquamative gingivitis).

What are the symptoms?

Mild oral lichen planus often causes no symptoms at all (NHS inform, University Hospitals Plymouth). When it does, the NHS, NHS inform and hospital leaflets list:

  • burning or stinging, especially when eating or drinking
  • red, sore areas or painful gums, which can make brushing uncomfortable
  • mouth ulcers, which Plymouth says are especially painful

The Oral Health Foundation says citrus fruits, tomatoes and hot or spicy foods can make a sore mouth worse.

On the skin, the NHS says lichen planus causes raised, purple-red blotches that can be itchy. DermNet says about half of people with it on the skin also have it in the mouth, but the mouth can be affected on its own.

What causes it?

The exact cause is not known. NHS inform and the Oral Health Foundation say it may be linked to the immune system. Some things can set off a lichenoid reaction, one that looks like lichen planus:

  • Medicines. The Oral Health Foundation lists some painkillers and medicines for diabetes and high blood pressure, including beta-blockers. University Hospitals of Leicester adds medicines for rheumatoid arthritis, and DermNet some antibiotics and antimalarials. Talk to your doctor if you think a medicine is involved.
  • Dental fillings. Leicester says silver (amalgam) fillings may cause lichenoid reactions, and the Cambridge leaflet says a filling next to the patches may be replaced.
  • Allergy to dental materials or toothpaste, particularly spearmint flavouring (DermNet).

Flare-ups may be linked to stress, particular foods or minor injury to the mouth (Cambridge, Leicester, DermNet).

Lichen planus is not an infection and cannot be passed on (NHS, Oral Health Foundation). The Oral Health Foundation and NHS inform say it does not usually run in families.

How is it diagnosed?

NHS inform says it is often found by a dentist at a routine check-up. Hospital leaflets say it can often be recognised by its appearance, but a biopsy is often needed to confirm it (Cambridge, Hull, Plymouth): a small piece of tissue is removed under local anaesthetic and examined under a microscope. DermNet says a biopsy also helps rule out mouth cancer.

How is it treated?

There is no cure, but treatment can ease symptoms (Oral Health Foundation, Cambridge). If it is not causing problems, the Cambridge and Hull leaflets say it needs no treatment, though you may be kept under review. When it is sore, options include:

  • Steroid treatments applied to the mouth, such as gels or creams (Oral Health Foundation) or a rinse that is spat out (Cambridge, Leicester). The NHS says mouthwashes and sprays from a GP can ease burning or sore gums.
  • A numbing mouthwash or spray, such as benzydamine (Cambridge), or a mild antiseptic mouthwash (Leicester).
  • Medicines that calm the immune system (Oral Health Foundation). DermNet says steroids taken internally may be used in severe cases.

A Cochrane review (2020) found that steroid creams applied to the mouth, such as clobetasol propionate or triamcinolone acetonide, may reduce pain, but found no evidence that they make the patches go away. Another medicine, tacrolimus, may work better but may cause more mild side effects. The reviewers rated most of the evidence as very low in reliability.

How long does it last?

It varies. The NHS says it can last several years, and Leicester says 10 to 15 years, flaring up and calming down. The Cambridge leaflet says some people have symptoms for only a few months, others for several years.

Looking after your mouth

  • Avoid foods and drinks that sting, such as spicy, salty or acidic foods, fruit juice, crusty bread and alcohol (NHS, NHS inform, Leicester). The Cambridge leaflet suggests a diary to spot triggers.
  • Keep your mouth clean. Brush carefully twice a day (NHS). See how to brush your teeth.
  • Toothpaste: advice differs slightly. NHS inform suggests your usual toothpaste if possible. Hospital leaflets suggest a milder one (Cambridge, Hull, Plymouth), and DermNet suggests one without sodium lauryl sulphate (SLS), a foaming agent, if yours irritates.
  • Use an alcohol-free mouthwash if alcohol makes your mouth sore (NHS, NHS inform).
  • Stop smoking (Leicester, DermNet) and keep alcohol within limits. The Cambridge leaflet suggests less than 14 units a week, to lower the risk of mouth cancer.
  • Eat soft, bland foods such as porridge when your mouth is sore (NHS inform).

There is a small one. The Oral Health Foundation says only a small number of people with long-term lichen planus develop mouth cancer. DermNet says it may rarely lead to mouth cancer, particularly the erosive form, and NHS inform says long-term erosive lichen planus can in some cases increase the chance of some cancers.

Hospital leaflets give different figures. The Cambridge leaflet puts the risk at 1% over 10 years. The Plymouth leaflet gives about 0.5 to 2% over 5 years in long-standing cases and calls this uncommon. Either way, most people with oral lichen planus do not develop mouth cancer.

This is why regular checks matter. The Cambridge leaflet advises a check-up every 6 months that includes checking for mouth cancer; Plymouth says every 6 to 12 months. DermNet says ulcers that do not heal and lumps that grow should be biopsied. See mouth cancer, white and red patches in the mouth and dental check-ups.

When to see your dentist or GP
  • You notice new white or red patches, lasting soreness or any change in your mouth (Oral Health Foundation).
  • An ulcer does not heal, or a lump appears or grows. See mouth cancer for how long to wait in the UK, Australia and the US.
  • Your mouth is so sore that eating is difficult. DermNet says severe cases can make it hard to eat enough.
  • You think you have lichen planus on your skin, nails, scalp or genitals (NHS: see a GP).
  • You think a medicine started in recent months may be involved (DermNet).

Frequently asked questions

Is oral lichen planus contagious?

No. The NHS and the Oral Health Foundation say you cannot catch it, and NHS inform says it cannot be passed on to other people, including sexual partners.

Is oral lichen planus cancer?

No. The Cambridge and Hull leaflets say it is not cancer. There is a small increased risk of mouth cancer, especially with the long-term erosive form, so your dentist will keep an eye on it.

Will it go away?

Sometimes. DermNet says it can clear within a few months or last for decades, with periods when it is better and worse. Treatment eases symptoms but does not cure it.

What is the difference between lichen planus and thrush?

Both can cause white patches. The Oral Health Foundation says lichen planus is not an infection. Oral thrush is treated with antifungal medicine, and in adults the NHS says its white patches can be wiped off, leaving red spots that can bleed. See oral thrush and mouth ulcers.

Sources

  1. Lichen planus, NHS, accessed September 2026
  2. Oral thrush (mouth thrush), NHS, accessed September 2026
  3. Lichen planus, NHS inform (Scotland), accessed September 2026
  4. Lichen planus, Oral Health Foundation, accessed September 2026
  5. Oral lichen planus, DermNet (dermnetnz.org), accessed September 2026
  6. Lichen planus of the mouth, Cambridge University Hospitals NHS Foundation Trust, approved December 2025, accessed September 2026
  7. Lichen planus, Hull University Teaching Hospitals NHS Trust, updated March 2025, accessed September 2026
  8. Oral lichen planus, University Hospitals Plymouth NHS Trust, issued January 2018, accessed September 2026
  9. Lichen planus in the mouth (PDF), University Hospitals of Leicester NHS Trust, leaflet 876, reviewed June 2026, accessed September 2026
  10. Corticosteroids for treating oral lichen planus, Cochrane (Lodi and others, 2020), accessed September 2026

This article is general information about oral health. It is not a diagnosis or a substitute for advice from a dentist or doctor who knows your situation. If you have pain, swelling, bleeding that does not settle, or a problem that is getting worse, see a dental professional. In an emergency, contact your local emergency service.

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