Oral lichenoid lesions (OLLs) are a diverse group of disorders that may be attributed to an autoimmune etiology, underlying systemic disease, or in association with an identifiable causative agent, such as a medication, food product, or dental material. OLLs commonly present with striae, erythema, and/or ulceration on affected oral mucosa and can be symptomatic. The aim of this report is to describe a case of OLLs that were believed to be attributed to use of household laundry detergent to clean an oral occlusal appliance

Nadeau, Christine

Stoopler, Eric T

English

ScholarlyCommons@Penn

University of Pennsylvania ScholarlyCommons Departmental Papers (Dental) Penn Dental Medicine 8-22-2013 Household Laundry Detergent as a Possible Cause of Oral Lichenoid Lesions Eric T. Stoopler University of Pennsylvania, ets@dental.upenn.edu Christine Nadeau University of Pennsylvania Follow this and additional works at: https://repository.upenn.edu/dental_papers  Part of the Allergy and Immunology Commons, Oral Biology and Oral Pathology Commons, and the Pathological Conditions, Signs and Symptoms Commons Recommended Citation Stoopler, E. T., & Nadeau, C. (2013). Household Laundry Detergent as a Possible Cause of Oral Lichenoid Lesions. Quintessence International, 44 (9), 699-701. http://dx.doi.org/10.3290/j.qi.a30180 This paper is posted at ScholarlyCommons. https://repository.upenn.edu/dental_papers/42 For more information, please contact repository@pobox.upenn.edu. Household Laundry Detergent as a Possible Cause of Oral Lichenoid Lesions Abstract Oral lichenoid lesions (OLLs) are a diverse group of disorders that may be attributed to an autoimmune etiology, underlying systemic disease, or in association with an identifiable causative agent, such as a medication, food product, or dental material. OLLs commonly present with striae, erythema, and/or ulceration on affected oral mucosa and can be symptomatic. The aim of this report is to describe a case of OLLs that were believed to be attributed to use of household laundry detergent to clean an oral occlusal appliance. Keywords laundry detergent, oral lichenoid lesion Disciplines Allergy and Immunology | Dentistry | Oral Biology and Oral Pathology | Pathological Conditions, Signs and Symptoms This journal article is available at ScholarlyCommons: https://repository.upenn.edu/dental_papers/42 VOLUME 44 • NUMBER 9 • OCTOBER 2013QUINTESSENCE INTERNATIONAL699ORAL MEDICINEHousehold laundry detergent as a possible  cause of oral lichenoid lesionsEric T. Stoopler, DMD, FDS RCSEd1/Christine Nadeau, DMD2Oral lichenoid lesions (OLLs) are a diverse group of disorders that may be attributed to an autoimmune etiology, underlying systemic disease, or in association with an identiﬁable causative agent, such as a medication, food product, or dental material. OLLs commonly present with striae, erythema, and/or ulceration on affected oral mucosa and can be symptomatic. The aim of this report is to describe a case of OLLs that were believed to be attributed to use of household laundry detergent to clean an oral occlusal appliance.  (Quintessence Int 2013;44:699–701; doi: 10.3290/j.qi.a30180)Key words: laundry detergent, oral lichenoid lesion1Associate Professor of Oral Medicine; Director, Oral Medicine Residency Program, Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsyl-vania, USA.2Resident, Department of Oral Medicine, University of Pennsyl-vania School of Dental Medicine, Philadelphia, Pennsylvania, USA.Correspondence: Dr Eric T. Stoopler, University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104, USA. Email: ets@dental.upenn.eduOral lichenoid lesions (OLLs) can represent a variety of clinical conditions including: oral lichen planus (OLP), an immune-medi-ated disorder; mucosal reactions that develop in direct relationship with a dental restorative material or food product; lesions that may be associated with other systemic diseases, such as hepatitis C; and drug reactions that arise in temporal relationship with ingestion of certain medications.1 Clini-cally, OLLs present as areas of radiating striae often accompanied by ulceration and erythema, which are often symptomatic.1 Histologically, OLLs demonstrate degenera-tion of the basal cell layer with a lympho-cytic inﬁltrate in the submucosal layers.2 OLLs secondary to an exogenous source will resolve in the majority of cases when the offending agent is eliminated.2 The aim of this report is to describe a case of OLLs that were believed to be attributed to use of household laundry detergent to clean an oral occlusal appliance.CASE REPORTA 71-year-old woman presented for evalu-ation of asymptomatic white lesions of the palate of 2 years duration that were discov-ered as an incidental ﬁnding on routine dental examination. A previous biopsy of the lesions demonstrated histopathology consistent with lichenoid mucositis. She denied use of mint, cinnamon, spices, new medications, or new oral hygiene products with the onset of the lesions. She reported a history of bruxism and used an acrylic max-illary occlusal appliance (OA) nightly for 3 years without evidence of oral mucosal lesions as per routine dental examination every 6 months. The patient did not report use of any cleaning agents for this OA. Subsequently, the patient had an identical OA fabricated and cleaned it with perfume- and dye-free household laundry detergent daily of her own accord with subsequent development of the palatal lesions. The patient denied any other mucosal or cuta-neous lesions. Her past medical history was significant for hypercholesterolemia, angina, previous myocardial infarction, and previous uterine malignancy. Medications included aspirin, simvastatin, loratadine/pseudoephedrine, and multivitamins. She reported true drug allergies to penicillin, meperidine, and codeine. Her family and social histories were unremarkable and her review of systems was signiﬁcant for inter-mittent bilateral knee pain.VOLUME 44 • NUMBER 9 • OCTOBER 2013QUINTESSENCE INTERNATIONA LStoopler/Nadeau700Physical examination revealed a well-nourished woman in no apparent distress. Extraoral examination did not reveal lymph-adenopathy, thyromegaly, salivary gland enlargement, or cutaneous lesions. Intraoral examination revealed a diffuse area of striae with erythema primarily on the palate (Fig 1).Examination of the OA revealed a heav-ily stained prosthesis retained by the maxil-lary dentition (Fig 2). Differential diagnosis consisted of OLLs believed to be caused by household laundry detergent and OLP, given the clinical and histopathologic fea-tures of the lesions. Treatment recommen-dations included cessation of OA use, com-pleting oral hygiene with baking soda and water only, and avoiding mint, cinnamon, and spices. She returned 1 month later and upon examination, the palatal lesions had significantly resolved and the patient remained asymptomatic (Fig 3).Fabrication of a new OA was recom-mended due to the likelihood that her cur-rent OA was saturated with household laun-dry detergent and the lichenoid lesions may re-occur if she continues to wear the device. The patient was reevaluated 6 weeks later and demonstrated continuing resolution of the palatal lesions (Fig 4). DISCUSSIONCutaneous reactions secondary to house-hold laundry detergent have rarely been reported. A multicenter study conducted by Belsito et al3 in 2002 concluded that allergic contact dermatitis caused by laundry deter-gents may occur at a rate of < 0.7% in der-matitic patients. In a study conducted by Magnano et al,4 several potential irritants were identiﬁed in 63 laundry detergent products available in Italy, including preser-Fig 1  Diﬀuse area of striae and erythema aﬀecting the central and vertical portions of the palate (arrows).Fig 3  Signiﬁcant resolution of central palatal lesions 1 month after cessation of OA use. Striae with mild erythema can be observed on the vertical por-tions of the palate only (arrows).Fig 2  Heavily stained acrylic maxillary occlusal appliance.Fig 4  Continued resolution of palatal lesions on 6 week reevaluation. The only remaining area of striae and mild erythema is noted on the vertical portion of the right palate (arrow).vatives methylchloroisothiazolinone (MCI), methylisothiazolinone (MI), 1,2-benzisothia-zolin-3-one, and fragrances such as butyl-phenyl methylpropional, hexyl cinnamal, and propylene glycol. In a prospective study conducted by Austoria et al,5 skin erythema and dryness were observed in subjects who were exposed to various laun-dry detergents commonly used in India. Although acrylic resin and its components have been associated with lichenoid muco-sitis,2 in the present case, the authors believe that the patient’s OLLs were attrib-uted to the household laundry detergent since no oral mucosal lesions were identi-ﬁ ed on routine dental examination with an identical OA worn previously that was not cleaned with this substance. Dental profes-sionals should provide speciﬁ c recommen-dations to patients regarding hygiene products for removable prostheses or devices (ie, dentures or OAs) to potentially avoid adverse oral reactions such as those described in this report.REFERENCES  1. Al-Hashimi I, Schifter M, Lockhart PB, et al. Oral lichen planus and oral lichenoid lesions: diagnostic and therapeutic considerations. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103(Suppl S25):e1–12. 2. DeRossi SS, Ciarrocca KN. Lichen planus, lichenoid drug reactions and lichenoid mucositis. Dent Clin North Am 2005;49:77–89. 3. Belsito DV, Fransway DF, Fowler JF Jr, et al. Allergic contact dermatitis to laundry detergents: a multi-center study to assess prevalence. J Am Acad Der-matol 2002;46:200–206. 4. Magnano M, Silvani S, Vincenzi C, Nino M, Tosti A. Contact allergens and irritants in household wash-ing and cleaning products. Contact Dermatitis 2009;61:337–341. 5. Austoria AJ, Lakshmi C, Srinivas CR, Anand CV, Mathew AC. Irritancy potential of 17 detergents used commonly by the Indian household. Indian J Dermatol Venereol Leprol 2010;76:249–253.Copyright of Quintessence International is the property of Quintessence Publishing CompanyInc. and its content may not be copied or emailed to multiple sites or posted to a listservwithout the copyright holder's express written permission. However, users may print,download, or email articles for individual use.

Household Laundry Detergent as a Possible Cause of Oral Lichenoid Lesions

Kosmopolis

University of Pennsylvania 
ScholarlyCommons 
Departmental Papers (Dental) Penn Dental Medicine 
8-22-2013 
Household Laundry Detergent as a Possible Cause of Oral 
Lichenoid Lesions 
Eric T. Stoopler 
University of Pennsylvania, ets@dental.upenn.edu 
Christine Nadeau 
University of Pennsylvania 
Follow this and additional works at: https://repository.upenn.edu/dental_papers 
 Part of the Allergy and Immunology Commons, Oral Biology and Oral Pathology Commons, and the 
Pathological Conditions, Signs and Symptoms Commons 
Recommended Citation 
Stoopler, E. T., & Nadeau, C. (2013). Household Laundry Detergent as a Possible Cause of Oral Lichenoid 
Lesions. Quintessence International, 44 (9), 699-701. http://dx.doi.org/10.3290/j.qi.a30180 
This paper is posted at ScholarlyCommons. https://repository.upenn.edu/dental_papers/42 
For more information, please contact repository@pobox.upenn.edu. 
Household Laundry Detergent as a Possible Cause of Oral Lichenoid Lesions 
Abstract 
Oral lichenoid lesions (OLLs) are a diverse group of disorders that may be attributed to an autoimmune 
etiology, underlying systemic disease, or in association with an identifiable causative agent, such as a 
medication, food product, or dental material. OLLs commonly present with striae, erythema, and/or 
ulceration on affected oral mucosa and can be symptomatic. The aim of this report is to describe a case 
of OLLs that were believed to be attributed to use of household laundry detergent to clean an oral 
occlusal appliance. 
Keywords 
laundry detergent, oral lichenoid lesion 
Disciplines 
Allergy and Immunology | Dentistry | Oral Biology and Oral Pathology | Pathological Conditions, Signs and 
Symptoms 
This journal article is available at ScholarlyCommons: https://repository.upenn.edu/dental_papers/42 
VOLUME 44 • NUMBER 9 • OCTOBER 2013
QUINTESSENCE INTERNATIONAL
699
ORAL MEDICINE
Household laundry detergent as a possible  
cause of oral lichenoid lesions
Eric T. Stoopler, DMD, FDS RCSEd1/Christine Nadeau, DMD2
Oral lichenoid lesions (OLLs) are a diverse group of disorders that may be attributed to an 
autoimmune etiology, underlying systemic disease, or in association with an identifiable 
causative agent, such as a medication, food product, or dental material. OLLs commonly 
present with striae, erythema, and/or ulceration on affected oral mucosa and can be 
symptomatic. The aim of this report is to describe a case of OLLs that were believed to be 
attributed to use of household laundry detergent to clean an oral occlusal appliance.  
(Quintessence Int 2013;44:699–701; doi: 10.3290/j.qi.a30180)
Key words: laundry detergent, oral lichenoid lesion
1Associate Professor of Oral Medicine; Director, Oral Medicine 
Residency Program, Department of Oral Medicine, University of 
Pennsylvania School of Dental Medicine, Philadelphia, Pennsyl-
vania, USA.
2Resident, Department of Oral Medicine, University of Pennsyl-
vania School of Dental Medicine, Philadelphia, Pennsylvania, 
USA.
Correspondence: Dr Eric T. Stoopler, University of Pennsylvania 
School of Dental Medicine, 240 South 40th Street, Philadelphia, 
PA 19104, USA. Email: ets@dental.upenn.edu
Oral lichenoid lesions (OLLs) can represent 
a variety of clinical conditions including: 
oral lichen planus (OLP), an immune-medi-
ated disorder; mucosal reactions that 
develop in direct relationship with a dental 
restorative material or food product; lesions 
that may be associated with other systemic 
diseases, such as hepatitis C; and drug 
reactions that arise in temporal relationship 
with ingestion of certain medications.1 Clini-
cally, OLLs present as areas of radiating 
striae often accompanied by ulceration and 
erythema, which are often symptomatic.1 
Histologically, OLLs demonstrate degenera-
tion of the basal cell layer with a lympho-
cytic infiltrate in the submucosal layers.2 
OLLs secondary to an exogenous source 
will resolve in the majority of cases when 
the offending agent is eliminated.2 The aim 
of this report is to describe a case of OLLs 
that were believed to be attributed to use of 
household laundry detergent to clean an 
oral occlusal appliance.
CASE REPORT
A 71-year-old woman presented for evalu-
ation of asymptomatic white lesions of the 
palate of 2 years duration that were discov-
ered as an incidental finding on routine 
dental examination. A previous biopsy of 
the lesions demonstrated histopathology 
consistent with lichenoid mucositis. She 
denied use of mint, cinnamon, spices, new 
medications, or new oral hygiene products 
with the onset of the lesions. She reported a 
history of bruxism and used an acrylic max-
illary occlusal appliance (OA) nightly for 3 
years without evidence of oral mucosal 
lesions as per routine dental examination 
every 6 months. The patient did not report 
use of any cleaning agents for this OA. 
Subsequently, the patient had an identical 
OA fabricated and cleaned it with perfume- 
and dye-free household laundry detergent 
daily of her own accord with subsequent 
development of the palatal lesions. The 
patient denied any other mucosal or cuta-
neous lesions. Her past medical history was 
significant for hypercholesterolemia, 
angina, previous myocardial infarction, and 
previous uterine malignancy. Medications 
included aspirin, simvastatin, loratadine/
pseudoephedrine, and multivitamins. She 
reported true drug allergies to penicillin, 
meperidine, and codeine. Her family and 
social histories were unremarkable and her 
review of systems was significant for inter-
mittent bilateral knee pain.
VOLUME 44 • NUMBER 9 • OCTOBER 2013
QUINTESSENCE INTERNATIONAL
Stoopler/Nadeau
700
Physical examination revealed a well-
nourished woman in no apparent distress. 
Extraoral examination did not reveal lymph-
adenopathy, thyromegaly, salivary gland 
enlargement, or cutaneous lesions. Intraoral 
examination revealed a diffuse area of 
striae with erythema primarily on the palate 
(Fig 1).
Examination of the OA revealed a heav-
ily stained prosthesis retained by the maxil-
lary dentition (Fig 2). Differential diagnosis 
consisted of OLLs believed to be caused 
by household laundry detergent and OLP, 
given the clinical and histopathologic fea-
tures of the lesions. Treatment recommen-
dations included cessation of OA use, com-
pleting oral hygiene with baking soda and 
water only, and avoiding mint, cinnamon, 
and spices. She returned 1 month later and 
upon examination, the palatal lesions had 
significantly resolved and the patient 
remained asymptomatic (Fig 3).
Fabrication of a new OA was recom-
mended due to the likelihood that her cur-
rent OA was saturated with household laun-
dry detergent and the lichenoid lesions may 
re-occur if she continues to wear the 
device. The patient was reevaluated 6 
weeks later and demonstrated continuing 
resolution of the palatal lesions (Fig 4). 
DISCUSSION
Cutaneous reactions secondary to house-
hold laundry detergent have rarely been 
reported. A multicenter study conducted by 
Belsito et al3 in 2002 concluded that allergic 
contact dermatitis caused by laundry deter-
gents may occur at a rate of < 0.7% in der-
matitic patients. In a study conducted by 
Magnano et al,4 several potential irritants 
were identified in 63 laundry detergent 
products available in Italy, including preser-
Fig 1  Diffuse area of striae and erythema affecting 
the central and vertical portions of the palate 
(arrows).
Fig 3  Significant resolution of central palatal 
lesions 1 month after cessation of OA use. Striae with 
mild erythema can be observed on the vertical por-
tions of the palate only (arrows).
Fig 2  Heavily stained acrylic maxillary occlusal 
appliance.
Fig 4  Continued resolution of palatal lesions on 6 
week reevaluation. The only remaining area of striae 
and mild erythema is noted on the vertical portion of 
the right palate (arrow).
vatives methylchloroisothiazolinone (MCI), 
methylisothiazolinone (MI), 1,2-benzisothia-
zolin-3-one, and fragrances such as butyl-
phenyl methylpropional, hexyl cinnamal, 
and propylene glycol. In a prospective 
study conducted by Austoria et al,5 skin 
erythema and dryness were observed in 
subjects who were exposed to various laun-
dry detergents commonly used in India. 
Although acrylic resin and its components 
have been associated with lichenoid muco-
sitis,2 in the present case, the authors 
believe that the patient’s OLLs were attrib-
uted to the household laundry detergent 
since no oral mucosal lesions were identi-
fi ed on routine dental examination with an 
identical OA worn previously that was not 
cleaned with this substance. Dental profes-
sionals should provide specifi c recommen-
dations to patients regarding hygiene 
products for removable prostheses or 
devices (ie, dentures or OAs) to potentially 
avoid adverse oral reactions such as those 
described in this report.
REFERENCES 
 1. Al-Hashimi I, Schifter M, Lockhart PB, et al. Oral 
lichen planus and oral lichenoid lesions: diagnostic 
and therapeutic considerations. Oral Surg Oral Med 
Oral Pathol Oral Radiol Endod 2007;103(Suppl 
S25):e1–12.
 2. DeRossi SS, Ciarrocca KN. Lichen planus, lichenoid 
drug reactions and lichenoid mucositis. Dent Clin 
North Am 2005;49:77–89.
 3. Belsito DV, Fransway DF, Fowler JF Jr, et al. Allergic 
contact dermatitis to laundry detergents: a multi-
center study to assess prevalence. J Am Acad Der-
matol 2002;46:200–206.
 4. Magnano M, Silvani S, Vincenzi C, Nino M, Tosti A. 
Contact allergens and irritants in household wash-
ing and cleaning products. Contact Dermatitis 
2009;61:337–341.
 5. Austoria AJ, Lakshmi C, Srinivas CR, Anand CV, 
Mathew AC. Irritancy potential of 17 detergents 
used commonly by the Indian household. Indian J 
Dermatol Venereol Leprol 2010;76:249–253.
Copyright of Quintessence International is the property of Quintessence Publishing Company
Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv
without the copyright holder's express written permission. However, users may print,
download, or email articles for individual use.


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Household Laundry Detergent as a Possible Cause of Oral Lichenoid Lesions

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