Severe oral erosive lichen planus due to methyldopa and allopurinol: a case report

Abstract

Oral lichen planus is a common condition with an unclear etiology although some common drugs have been implicated. We report on a 75-year-old Chinese woman with painful erosions and ulceration of the lateral tongue, gingivae, and buccal mucosa who had been taking methyldopa for several years and allopurinol for more than a month. Following the classic bilateral presentation, a provisional clinical diagnosis of oral erosive lichenoid planus was made and drug therapy changed to metoprolol and paracetamol. Topical steroids, analgesic, and antiseptic mouth rinse were prescribed. After 6 weeks, all lesions had resolved although a few Wickham’s striae remained. The patient’s oral function was restored and to date the lesions are in remission. It appears that proper identification of the causative drug together with its immediate withdrawal and adjunctive topical therapy is an effective method for treating drug-induced lichenoid reactions.