Is there a connection between Oral Lichen Planus and stiff palpable lymph nodes !

Hello,

Lichen planus is basically a skin disease which can often affect the mouth. I suppose you do not have Lichen planus spots anywhere else on your skin? That diagnosis in the your mouth, is much more likely to be correct if you have skin spots of Lichen planus somewhere else on your body, - it may be worth looking carefully again.

Lichen planus spots on the front of the wrist, (click) http://www.healthwatchcenter.com/wp-cont…

Lichen planus nail changes, (thimble pits), - (click) http://www.wikidoc.org/images/thumb/c/cb…

There is cross-over of interests between Oral Surgeons, and skin Dermatologists who of course, see ordinary body Lichen planus all the time. If there is any doubt about whether you have Lichen planus spots on your body, your Oral Surgeon should ask a Dermatologist kindly to have a look at you, in my opinion.

According to the dermatologist Habif's "bible" textbook, Lichen planus in the mouth is rare before middle age. The mean age of onset is in the 50's. Women outnumber men by more than 2 to 1. There are 2 stages of severity. The most common and least severe form, is the appearance of "white networks" inside the cheeks. The more severe form is the appearance of erosions or extensive ulcerations inside the mouth, (presumably this is the kind that you have?). Oral thrush, may occur on top of the problem, in about 1 in every 5 cases. Cancerous change, occurs in the Lichen planus mouth ulcers in about 1.2% (one point two percent, 1 in 100) of cases.

Enlarged lymph nodes are not a classic feature of Lichen planus in the mouth, or indeed elsewhere. Secondary infection of the mouth ulcers with bacteria or Thrush, or rarely malignant change, may be responsible.

There are lots of separate groups of lymph-nodes in the neck, and they accept the lymph-drainage from the mouth strictly according to which lymph-nodes are the nearest, the closest, to the source.

Here is a pic of the main lymph-node groups, (click) http://www.aafp.org/afp/2002/0901/afp200… - I wonder which group, your enlarged ones are in?

I am saying that if your enlarged lymph-nodes are connected to the oral Lichen planus, they should match up in terms of natural lymph-drainage. If they don't match up, anatomically, then one obviously looks for another cause in that source region which *does* match up.

For example, a Lichen planus ulcer inside the left-hand-side of your mouth, - (say), - would not match up with swellings in your neck's right-sided sub-mandibular lymph-node group.

I am not sure whether you understand what "smooth surface," "palpable" and "mobile" mean? I understand from these descriptions that the lymph-nodes probably do not contain secondary cancer. But swollen lymph-nodes are not "normal," no, - there is some cause for the swelling.

I think that if these lymph nodes are troubling you in their own right, then the nature of their swelling should be clarified further. The way to do this, is to ask for one of them to be removed (under local anaesthetic), and then sent for examination under the microscope, at your local hospital. The technical medical name for this procedure is a "biopsy," pronounce BYE''- op - see.

Also, if the prescribed treatment has failed to improve the mouth spots, then the whole diagnosis should first be re-considered, in my opinion, (before any stronger treatment is advised). I think you should consider asking for one of your worst mouth ulcers to be biopsied as well, (unless you have Lichen planus somewhere else on the rest of your skin).

One is worried about the remote possibility of a mouth cancer, with secondary spread to the lymph nodes in the neck, isn't one, - -

- (1) Especially if you are a heavy smoker, or a heavy alcohol drinker, or if your mouth (teeth) hygiene is poor? - for ordinary "primary" mouth cancers, or

- (2) if you have the more severe Lichen planus mouth ulcers, there is a 1.2% chance (1 in 100) of cancerous change taking place in one of the ulcers; that would make it appear as the "worst" ulcer; it might bleed.

Your blood test results are fine so far as they go, but that isn't perhaps very far. They probably indicate that you don't have a severe infection going on anywhere, (including inside your mouth and neck), and that your disease is not associated with Hepatitis, - but otherwise I think they are pretty inconclusive. They certainty don't exclude anything serious going on in your mouth or neck. You need something that is better targetted for that, in my opinion, (i.e. biopsies and a Dermatology skin consultation). You are going to have to combine tact and diplomacy, with insistence.

I hope this is of some help. If you need to me to re-explain anything more simply, please let me know, <belliger@nym.hush.com>

Best wishes,

Belliger
retired uk gp

You should probably seek the advice of your primary care physician and have them get to the bottom of the swollen lymph nodes. OLP has been reported as a complication of chronic hepatitis C virus infection and can be a sign of chronic graft-versus-host disease of the mucous membrane