Oral Lichen Planus Patient Registry

  • Oral Lichen Planus Patient Registry

    Survey page

  • Oral Lichen Planus (OLP) is a chronic inflammatory disease that affects the mucous membranes inside the mouth, causing pain and discomfort, and significantly impacting the quality of life for those affected. This condition, which affects over 6 million Americans, often presents with lesions that can be painful and ulcerative. The exact cause of OLP remains unknown, but it is believed to involve an immune response where the body's white blood cells attack the mucosal lining of the mouth. Current therapeutic options are limited and the urgent need for effective treatments has driven ongoing research and clinical trials. 

    The potential uses for this registry about OLP include: improving the scientific understanding of oral lichen planus, discovering trends and common needs of registry participants, describing the aggregate personal characteristics of patients within the registry, documenting registry patient history, and contacting registry participants to inform them of new studies. 

    Thank you for the generous contribution of your valuable time spent helping us grow a resource to help doctors better understand and treat oral lichen planus

    Signup is easy. The form takes less than 5 minutes to complete.

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  • What is your relationship to the patient(s) living with Oral Lichen Planus?
  • Format: (000) 000-0000.
  • May we contact you about (select all that apply):

  • Patient Demographic Information (OPTIONAL SECTION)

  • Sex: What is the patient's sex?
  • Ethnicity: Is the patient of Hispanic, Latino/a, or Spanish origin?
  • Race: What is the patient's race? (Select all that apply.)

  • Patient OLP Symptoms Information (OPTIONAL SECTION)

  • Think about your experience over the past 24 hours while you were awake. Choose the best answer for "How much of the time did you have oral lichen planus symptoms?"
  • Think about your experience over the past 24 hours while you were awake. Choose the best answer for "At their worst, how severe were your oral lichen planus symptoms?"
  • Overall, what is the severity of your oral lichen symptoms on a number scale of 0 to 10.
  • Do you currently limit what you eat or drink due to your OLP symptoms?

  • Patient OLP Treatment Information (OPTIONAL SECTION)

  • Have you had an oral cavity biopsy within the last 10 years?
  • Have you ever tried tacrolimus (Prograft/Protopic) to treat your OLP symptoms? If Yes, in what form?
  • Have you ever used a steroid to treat your OLP symptoms? If Yes, in what form?
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