A scoring system for mucosal disease severity with special reference to oral lichen planus

Background To date, there is only weak evidence for the superiority of any interventions over placebo for the palliation of symptomatic oral lichen planus (LP). Further research involving large placebo-controlled, randomized clinical trials is needed. These will require carefully selected and standardized outcome measures. Objectives To formulate a scoring system for intraoral LP. Methods One hundred and fifty-six patients with biopsy-confirmed LP were scored at the first and subsequent visits according to (i) extent of site involvement, (ii) disease activity at each site and (iii) an overall pain score as reported by the patient. Overall differences between clinical variants of LP were analysed using the Kruskal–Wallis test and pairwise differences by the Mann–Whitney U-test. Clinical sensitivity (Wilcoxon signed-rank test) was assessed by scoring patients before and after treatment (n = 23). Results Reticular LP (n = 48) was the commonest single type of clinical presentation, followed by ulcerative (n = 30), atrophic (n = 22), desquamative (n = 18) and plaque (n = 1). The median severity and activity scores were 13/6 (reticular), 39/20 (ulcerative), 20/9 (atrophic) and 23/11 (desquamative). Two or more clinical variants were seen in 37 cases. Statistical significance was observed for differences between clinical variants (P <0·0001) and variation in scores (P <0·01) when ulcerative LP was compared with all other types. Clinical sensitivity was statistically significant (P <0·01), while reproducibility was high and allowed the response to therapy to be easily assessed. Conclusions It is suggested that this scoring system is easy to use, reproducible and sensitive enough to detect clinical responses to therapy.