Can deram be a cause of oral lichen planus?

To study the relationship between oral lichen planus [LP] and the habit of chewing deram. A clinically based controlled observational study including a total of 176 women who used to chew deram and 200 women who never used deram, who consulted the Dermatology Department of Basrah Teaching Hospital, and a private clinic, Barsah, Iraq during the period from February 2005 to July 2007. The study showed that the incidence of oral LP is greater among 176 deram chewers [23.3%] in comparison with 200 women who never use deram [1.5%], particularly among those with frequent [51.2%] and prolonged [65.8%] chewing of deram. Oral lesions, were mostly asymptomatic [80.5%] and predominantly of reticulate pattern [87.9%]. Avoidance of deram chewing induced marked or complete improvement of the oral lesions in 56.3% of cases even without treatment within a 3 month follow up period. Pathological examination showed features similar to classical LP. Deram chewing should be considered as a possible cause of oral LP, particularly among frequent and prolonged chewers