Oral lichen planus: a literature review and update

Molecular evidence for the efficacy of PBM therapy in the treatment of oral lichen planus

PURPOSE

Oral lichen planus (OLP) is a chronic inflammatory disease, in which T-Lymphocytes induce apoptosis of basal keratinocytes, leading to the formation of symptomatic lesions. It is assumed that blocking the cell death program and enhancing cell proliferation would be crucial to the healing process. The aim of the study was to verify the efficacy of Photobiomodulation (PBM) in OLP management, by evaluating the effects of laser irradiation on the processes of apoptosis and cell proliferation.

METHODS

Twenty patients with OLP underwent PBM with 810 nm diode laser (0.5 W, 30 s, 1.2 J/cm2), 3 times a week for one month. The size and clinical scores of the lesions and pain level were recorded and compared before and after therapy using Thongprasom sign scoring system and Visual Analogue Scale, respectively. Biopsies were taken before and after therapy and analyzed immunohistochemically for bcl-2 and Ki-67 expression. Tissue sections from 10 healthy volunteers were used as controls for the levels of these markers in normal oral mucosa.

RESULTS

PBM significantly reduced patients' pain intesity and improved the clinical signs of the lesions. OLP tissue sections demonstrated lower staining for bcl-2 and Ki-67 compared to healthy controls. After therapy the expression of bcl-2 increased significantly. An enhance in Ki-67 immunoreactivity was revealed predominantly in the atrophic-erosive epithelium.

CONCLUSION

PBM is an effective treatment modality for OLP patients. Erosive forms of the disease responded better to laser irradiation than keratotic subtypes. At the molecular level, PBM is likely to recover the impaired cell cycle mechanisms and keratinocyte proliferation.

The Role of TRPV1/CGRP Pathway Activated by Prevotella melaninogenica in Pathogenesis of Oral Lichen Planus

The distinctive clinicopathologic characteristics of OLP indicated that both microbial dysbiosis and neurogenic inflammation may be jointly involved in its progression, and transient receptor potential vanilloid receptor-1 (TRPV1) may be a crucial element. The purpose of this study was to explore how TRPV1 mediated P. melaninogenica-induced inflammation. Meanwhile, we aimed to unravel how IL-36γ dysregulated the barrier function in oral keratinocytes. Here, the expression of TRPV1, calcitonin gene-related peptide (CGRP), and its receptor receptor activity-modifying protein 1 (RAMP1) in OLP patients were detected. Prevotella melaninogenica (P. melaninogenica) was used to build a mouse model of oral chronic inflammation. Normal human oral keratinocytes (NHOKs) stimulated by P. melaninogenica were used to examine TRPV1 activation and CGRP release. To investigate the effect of exogenous CGRP on Interleukin-36 gamma (IL-36γ) expression in NHOKs and bacterial viability, P. melaninogenica and NHOKs were treated with it, respectively. Recombinant IL-36γ protein was used to probe its regulation of oral epithelial barrier function. TRPV1, CGRP, and RAMP1 were substantially expressed in OLP. P. melaninogenica increased TRPV1 expression in mice and caused the release of CGRP and an increase in pro-inflammatory cytokines via activating TRPV1 in NHOKs. Blockade of TRPV1 suppressed P. melaninogenica-induced inflammation. CGRP boosted the production of IL-36γ released by NHOKs, resulting in lower expression of zonula occludens-1 (ZO-1). Also, CGRP can decrease the viability of P. melaninogenica. Together, these findings provide fresh insight into the vital role performed by P. melaninogenica-induced functional changes in oral epithelial cells and neurons in an intricate OLP inflammatory process.

The association between skin allergy testing and oral squamous cell carcinoma in oral lichen planus: a retrospective cohort study

There is a reported association between oral contact allergy and oral lichen planus (OLP). Likewise oral squamous cell carcinoma (oSCC) is associated with OLP. It is hypothesized that chronic inflammation may contribute to oSCC risk. Ostensibly, we hypothesized that allergy testing positivity may increase inflammation and thus may be associated with oSCC in OLP. As a secondary objective, we assessed oSCC prevalence in OLP, allergen prevalence in OLP, and associations between allergy testing and OLP phenotype. To do this, we performed a retrospective cohort evaluation of OLP patients seen at the University of Utah from 2015 to 2022. Odds of oSCC occurrence by allergy testing status, clinical/demographic factors and asssociations between allergy testing and OLP phenotype were assessed using univariable and multivariable logistic regression. The prevalence of oSCC and allergy testing (patch + scratch testing) results were summarized descriptively. OLP diagnoses were confirmed by our OLP-specialized clinicians, and/or histologic assessment. Allergy testing was performed by two specialized dermatologists. oSCC diagnosis was identified via chart review and histologic data. Among 587 OLP patients identified, 133 were allergy tested and 77.4% were positive (52.4% metals, 55.3% flavorings/fragrances, 47.6% preservatives). Of those with a positive allergy test, 10 (25.6%) developed oSCC compared with 2 (5.1%) of patients with a negative allergy test. There was insufficient evidence to support an association between allergy positivity and oSCC (OR = 1.55, 95% CI 0.76-3.15). A higher percent of symptomatic visits was the only other clinical and/or demographic factor associated with oSCC occurrence (median 87.5% vs. 66.7%, p = 0.03). Of the OLP disease characteristics assessed (mouth area involved, extent of disease involvement, erosive subtype, etc.), only OLP involving the gingiva was associated with positive allergy testing (OR = 2.54,1.11-5.81). These data suggest that allergy test positivity may not be associated with oSCC. However, it was associated with more pervasive symptomatology, suggesting a possible association with more severe or recalcitrant disease.

Retrospective Analysis of Blood Inflammatory Biomarkers in Patients with Oral Lichen Planus: Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio

Objectives: Oral lichen planus (OLP) is a potentially malignant disorder and a chronic inflammatory condition of an immune nature. The aim of this study was to investigate the association between immune-inflammatory biomarkers in patients with OLP and a control group. Materials and Methods: This was a retrospective study with 129 patients (62 with OLP and 67 controls) in which clinical and laboratory data were analyzed. The neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), the mean platelet volume (MPV) index, and the parameter of systemic immune-inflammation index (SII) were assessed. Results: In patients with OLP, the average time of progression was significantly longer when the condition manifested in the atrophic-erosive form (4.3 ± 3.2 years) as opposed to the reticular form (1.8 ± 0.9 years) (p = 0.018). With regard to NLR, no differences were found in terms of age (p = 0.346 (r = 0.08)), tobacco use (p = 0.807), sex (p = 0.088), alcohol consumption (p = 0.281), clinical form of OLP (p = 0.55), time of progression of OLP (p = 0.309 (r = -0.13)), and number of sites (p = 0.217). The same was observed for the systemic immune-inflammation index. Conclusion: The lack of significant statistical associations between the biomarkers and parameters (NLR, PLR, MPV, and SII index) in patients with oral lichen planus makes such parameters of very limited use in clinical OLP practice.

Oral Lichen Planus: Clinical Presentation, Demographic Characteristics, and Risk Factors in a Retrospective Study of 186 Polish Patients

Background/Objectives: Lichen planus (LP) is a chronic, recurrent mucocutaneous inflammatory disease that develops due to a disturbed immunological response triggered by endogenous and exogenous factors. To evaluate clinical presentation, demographic characteristics, and risk factors in a cohort of Polish patients with oral lichen planus (OLP). Methods: Medical records of 186 patients with OLP referred to the student outpatient clinic in Poznań University of Medical Sciences from 2013 to 2023 were analyzed in order to establish clinical presentation, patient's demographic characteristics, and risk factors for OLP. We considered data regarding age, sex, medical history, habits, subjective complaints, clinical type, localization, histology, and treatment. Results: Patients with OLP constituted 20.1% of 887 admitted patients. Of the 186 patients with OLP, 130 (69.9%) were females and 56 (30.1%) were males. The average age at the diagnosis was 60.7 years (range 15-95 years). Only 24.2% of patients reported smoking. The most common intraoral presentation of OLP was reticular form (61.8%), followed by mixed erosive-bullous type (15%), and atrophic (6.4%). Pathologic lesions were most commonly located on buccal mucosa (89.2%) and tongue (58.6%). Subjective complaints included pain (48.4%), burning sensation (46.2%), xerostomia (25.3%), bleeding (10.2%), taste disturbance (4.8%), and excessive saliva production (3.8%), while 22.6% of OLP patients were asymptomatic. Conclusions: The most common type of OLP in Polish patients was reticular, developing mostly on the buccal mucosa and tongue. It was found most often in non-smoking middle-aged women. Subjective complaints were reported by over 77% of patients.

Artificial Intelligence Diagnosing of Oral Lichen Planus: A Comparative Study

Early diagnosis of oral lichen planus (OLP) is challenging, which traditionally is dependent on clinical experience and subjective interpretation. Artificial intelligence (AI) technology has been widely applied in objective and rapid diagnoses. In this study, we aim to investigate the potential of AI diagnosis in OLP and evaluate its effectiveness in improving diagnostic accuracy and accelerating clinical decision making. A total of 128 confirmed OLP patients were included, and lesion images from various anatomical sites were collected. The diagnosis was performed using AI platforms, including ChatGPT-4O, ChatGPT (Diagram-Date extension), and Claude Opus, for AI directly identification and AI pre-training identification. After OLP feature training, the diagnostic accuracy of the AI platforms significantly improved, with the overall recognition rates of ChatGPT-4O, ChatGPT (Diagram-Date extension), and Claude Opus increasing from 59%, 68%, and 15% to 77%, 80%, and 50%, respectively. Additionally, the pre-training recognition rates for buccal mucosa reached 94%, 93%, and 56%, respectively. However, the AI platforms performed less effectively when recognizing lesions in less common sites and complex cases; for instance, the pre-training recognition rates for the gums were only 60%, 60%, and 20%, demonstrating significant limitations. The study highlights the strengths and limitations of different AI technologies and provides a reference for future AI applications in oral medicine.

Halitosis in oral lichen planus patients

To investigate the halitosis level in oral lichen planus (OLP) patients and OLP-free participants. This cross-sectional study recruited 70 participants at the New Zealand's National Centre for Dentistry. Halitosis was determined using the objective measurements (parts per billion (ppb) volatile sulphur compounds (VSCs) in the exhaled air) and subjective measurement (self-reported halitosis questionnaire). The VSCs values of OLP participants (mean ± SD: 144.64 ± 23.85 ppb) were significantly greater than that in the OLP-free participants (105.52 ± 22.31ppb) (mean difference: 39.12 ppb;p< 0.05; 95% CI: 27.95, 50.29). The VSCs value of hyperplastic (mean difference: 34.11; 95% CI: 20.07, 48.15;p< 0.05) and erosive/ulcerative (mean difference: 57.47; 95% CI: 34.19, 80.76;p< 0.05) OLP participants were statistically greater than that of OLP-free participants. No statistical significance was found between hyperplastic and erosive/ulcerative OLP (p> 0.05). 'Type (OLP-free/OLP)' has a significant effect on the dependent variable VSCs. 78.6% of OLP and 90.5% of OLP-free brushed their teeth at least twice daily, with a statistically significant observation (Mean square: 1.61; F: 13.13;p< 0.05). The levels of VSCs were greater in participants with hyperplastic and erosive/ulcerative OLP than that in the OLP-free participants.

Rationale for the Use of Topical Calcineurin Inhibitors in the Management of Oral Lichen Planus and Mucosal Inflammatory Diseases

Oral lichen planus (OLP) is a chronic inflammatory condition that affects the mucous membranes of the oral cavity and is characterized by a T-cell-mediated autoimmune response. It presents a therapeutic challenge due to its relapsing nature, causing significantly decreased quality of life and, in some cases, increasing the risk of malignant transformation. While topical corticosteroids have long been the first-line therapy for OLP, their long-term use is associated with adverse effects, such as mucosal atrophy and candidiasis. This has driven interest in alternative therapies, particularly topical calcineurin inhibitors (TCIs), such as tacrolimus, which offer a steroid-sparing approach. This review explores the pathophysiological basis of OLP, examines the role of TCIs in its treatment, and evaluates emerging therapies, with a specific focus on the use of a topical liposomal formulation of tacrolimus. These formulations aim to achieve high local drug concentrations while minimizing systemic absorption. OLP is a complex and multifactorial disease that requires a multifaceted approach to management. While current therapies provide symptomatic relief, there is a need for more effective and safer treatment options. Emerging therapies, including advanced drug delivery systems, biologics, and alternative therapies, hold promise for improving the management of OLP. Future research should focus on identifying novel therapeutic targets and developing strategies that can achieve sustained remission with minimal side effects.

Expression of Programmed Death Ligand 1 and Indoleamine 2,3-Dioxygenase in Oral Lichen Planus and Oral Lichenoid Lesions

BACKGROUND

Oral lichen planus (OLP) and oral lichenoid lesions (OLL) are inflammatory T-cell mediated disorders of the oral mucosa (OM). Both are associated with an increased risk of oral squamous cell carcinoma, with OLL possibly having a higher rate of malignant transformation than OLP. Programmed death ligand 1 (PD-L1) and indoleamine 2,3-dioxygenase (IDO) are immunosuppressive molecules possessing inhibitory effect on T-cells and have been implicated in carcinogenesis. The aim of this study was to examine the expression of PD-L1 and IDO in OLP and OLL.

METHODS

Sixty-eight formalin-fixed, paraffin-embedded tissue samples diagnosed as OLP, compatible with OLP, or OLL were divided into OLP (n = 39) or OLL (n = 29) groups based on both clinical and histopathological diagnostic criteria. Samples of healthy OM (n = 9) served as controls. Samples were immunohistochemically stained for PD-L1 and IDO, and staining distribution and intensity were evaluated.

RESULTS

Immunohistochemical expression of PD-L1 was increased in the basal and intermediate layers of epithelium in OLP and in lamina propria in both OLP and OLL compared to controls. OLP and OLL showed increased expression of IDO in epithelium and lamina propria compared to controls. PD-L1 staining intensity in the basal epithelial layer, and IDO staining intensity in lamina propria were increased in OLP compared to OLL.

CONCLUSION

The results indicate that the expression of PD-L1 and IDO increases in OLP and OLL, suggesting that these molecules may play a role in the pathogenesis of both disorders.

Orofacial Pain

OBJECTIVE

This article explores the multiple etiologies, diagnosis, and management of orofacial pain.

LATEST DEVELOPMENTS

Published in 2019, the International Classification of Orofacial Pain has become the internationally accepted classification system for primary and secondary facial pain. New discoveries in temporomandibular disorders have demonstrated that they are far more complex than the traditional dental mechanistic point of view. A 2020 consensus report released by the National Academies of Sciences, Engineering, and Medicine entitled "Temporomandibular Disorders: Priorities for Research and Care" highlighted this paradigm shift and its importance for patient care, education, and research.

ESSENTIAL POINTS

Orofacial pain comprises many disorders with different etiologies and pathophysiologies. The subjectivity of the pain experience and the interrelated anatomy and physiology of the craniofacial area add to the complexity of diagnosis when the source and etiology of pain are not clear. As orofacial pain straddles the expertise of multiple disciplines, a multidisciplinary approach combining medication, physical therapy, and procedural and psychological strategies is essential in treating patients with orofacial pain.

Effectiveness of Fenugreek as an Adjuvant in the Management of Oral Potentially Malignant Disorders: A Randomized Controlled Trial

AIM

This study aimed to evaluate the effectiveness of fenugreek as an adjuvant in managing oral potentially malignant disorders (OPMDs), specifically leukoplakia, lichen planus, and oral submucous fibrosis (OSMF).

MATERIALS AND METHODS

Twenty-one participants prediagnosed with OPMDs were randomly divided into a study group (SG) and a control group (CG), with 10 participants in SG and 11 in CG, respectively. The SG received 2 gm of fenugreek as an adjuvant with standard systemic treatments tailored to the respective lesions: intralesional injection of vitamin A 1,00,000 IU (Aquasol A) and topical application of triamcinolone acetonide 0.1% (Kenacort) for 2 months for leukoplakia. Subjects with oral lichen planus were administered prednisolone 5 mg/day (Wysolone), chlorhexidine mouthwash 0.2% (Peridex), and Zincovit once daily for 8 weeks. For subjects with OSMF, one capsule of SM Fibro once daily for 12 weeks along with dexamethasone 1.5 mL (Decadron) was given, and hyaluronidase 1,500 IU (Hynidase) with 0.5 mL lignocaine HCL (Xylocaine) was injected intralesionally biweekly and mouth exercise was advised for 2 months; control group received only the standard treatment. Sociodemographic data were collected, and clinical assessments, evaluating size and shape for leukoplakia, erythema, and burning sensation for oral lichen planus, and mouth opening, cheek flexibility, and burning sensation for OSMF were assessed from baseline through 2 months. Data collected were organized in Excel and analyzed using Statistical Package for the Social Sciences version 21.0.

RESULTS

The SG and CG had 10 and 11 participants, with 4 in each group for leukoplakia, 2 participants in SG and 3 in CG for lichen planus, and 4 participants for OSMF in each group, respectively. Most participants presented with leukoplakia under 2 cm on the buccal mucosa bilaterally, with no significant changes in size or shape postintervention. For lichen planus, mild erythema and burning sensation were noted, but there were no significant differences within or between groups postintervention. A mild burning sensation, a statistically significant improvement in mouth opening was observed in SG (p < 0.051) when compared with CG after 8 weeks postintervention in OSMF. Also, significant improvement in cheek flexibility was noted from baseline to the fourth follow-up in SG post intervention. However, there were no differences between groups during the follow-up period.

CONCLUSION

The findings from this trial suggest that SG showed significant improvement in OSMF than CG, whereas the improvements in leukoplakia and lichen planus remained same in both groups.

CLINICAL SIGNIFICANCE

Fenugreek, being a cost-effective and affordable agent known for its anticancer, anti-inflammatory, antioxidant, and antiulcerative properties, could be used as an adjuvant for its management in OPMDs. How to cite this article: Balasundaram N, Narayanan MBA, Arul Antony LS, et al. Effectiveness of Fenugreek as an Adjuvant in the Management of Oral Potentially Malignant Disorders: A Randomized Controlled Trial. J Contemp Dent Pract 2024;25(10):921-929.

Translational Research in Oral Lichen Planus: From Laboratory Discoveries to Clinical Applications

Oral lichen planus (OLP) is a chronic inflammatory condition that affects the oral mucous membrane, causing discomfort and pain for millions of people worldwide. Challenges in managing OLP include its chronic nature, varied clinical manifestations, poor patient compliance, and potential for malignant transformation. Recent breakthroughs in the therapy of OLP have opened up new paths for dental practitioners, yet persistent difficulties require attention. Topical calcineurin inhibitors, photodynamic treatment, and biologics have all demonstrated success in relieving symptoms and delaying disease progression. Furthermore, advances in understanding OLP's immunopathogenesis have revealed new targets for targeted treatments, raising hopes for more tailored therapy methods. However, obstacles remain, particularly in the area of long-term treatment and the danger of malignant transformation, needing close monitoring and interdisciplinary teamwork. This review will attempt to explore all of the therapeutic strategies for treating OLP that have been addressed in the literature.

Topical tacrolimus orabase versus topical clobetasol propionate orabase in the treatment of symptomatic oral lichen planus: a pilot randomized study

OBJECTIVES

This pilot study aimed to compare the efficacy of 0.1% tacrolimus and 0.05% clobetasol propionate in orabase for treating symptomatic oral lichen planus (OLP).

MATERIALS AND METHODS

Pilot, randomized, and controlled study conducted on 21 patients with symptomatic OLP, selected according to the clinical and histopathological criteria of Cheng et al. 2016. Twelve patients received 0.1% tacrolimus, and nine received 0.05% clobetasol, both in orabase for 30 days with a two-month follow-up. The patients were examined for scores of signs (ODSS), symptoms (VAS), quality of life (OHIP-14), anxiety (Beck Anxiety Scale), and treatment satisfaction (Hedonic Scale).

RESULTS

Both treatments were effective in reducing ODSS, VAS, and Beck Anxiety Scale scores and performed well on the hedonic scale, yet without statistical difference between them. However, at the 1-month follow-up, patients in group Clobetasol showed a greater percentage reduction in ODSS score compared to baseline by 50% (p = 0.02) and significantly lower average values (p = 0.03) than those in group Tacrolimus. Longitudinal intragroup analysis revealed significant improvements over time in both groups for ODSS, and only in the tacrolimus group for OHIP-14 and Beck scores.

CONCLUSIONS

Both tested protocols were effective over a three-month follow-up. However, due to the lower cost of clobetasol propionate it can be considered the first-choice option. Tacrolimus in orabase formulation may be a promising alternative for refractory lesions that do not respond to topical steroids.

CLINICAL RELEVANCE

Managing symptomatic OLP is challenging. Comparisons between tacrolimus and clobetasol propionate in orabase formulations have not yet been thoroughly explored.

Tinidazole mouth rinse for the treatment of oral lichen planus: an observational pilot study

BACKGROUND

Given the limited treatment options available for oral lichen planus (OLP), a study was undertaken to obtain preliminary information on the therapeutic efficacy of tinidazole mouth rinse in patients with OLP.

METHODS

A prospective, open-label pilot study was conducted to assess the efficacy of thrice-daily tinidazole mouth rinse for one week in OLP patients (n = 27). Reticulation/erythema/ulceration (REU) scores and visual analog scale (VAS) scores were used to measure lesions at baseline and after one week of treatment. Mucosal samples were collected, and the abundance of Fusobacterium nucleatum was quantified using RT-PCR. Statistical analysis using t-test, Wilcoxon signed rank test and Pearson correlation test.

RESULTS

After treatment, VAS scores significantly decreased in both reticular (P = 0.03) and erosive OLP patients (P = 0.003). However, REU scores significantly decreased only in erosive OLP patients (P = 0.002). The relative abundance of Fusobacterium nucleatum on the damaged mucosa surface significantly decreased in all OLP patients (P = 0.01). In erosive OLP patients, the triamcinolone group showed a significantly greater improvement in VAS scores compared to the tinidazole group (P = 0.01). However, there was no statistically significant correlation between the relative abundance of Fusobacterium nucleatum and REU scores in OLP patients (r = 0.0754, P = 0.61).

CONCLUSION

Tinidazole mouth rinse showed potential in reducing disease severity in OLP patients and was well-tolerated, suggesting its viability as a local therapeutic option. However, randomized controlled studies are warranted to confirm these preliminary findings.

Oral Lichen Planus: A Narrative Review Navigating Etiologies, Clinical Manifestations, Diagnostics, and Therapeutic Approaches

Background/Objectives: Oral Lichen Planus (OLP) is a common immune-mediated inflammatory disorder affecting the oral mucosa, impacting 0.5% to 2% of the global population, primarily middle-aged women. Immunological dysregulation is a key factor in OLP's pathogenesis, involving CD4+ T helper and CD8+ T cytotoxic cells. The World Health Organization (WHO) classifies OLP as a potentially malignant disorder, with a risk of oral squamous cell carcinoma (OSCC) developing in up to 2% of lesions. This narrative review aims to provide a comprehensive overview of the etiopathogenesis, clinical manifestations, diagnostic criteria, and therapeutic strategies for OLP, informing clinical practice and guiding future research. Methods: A review of the literature from the PubMed and Google Scholar databases was conducted up to December 2023, focusing on studies addressing the etiopathogenesis, diagnosis, clinical manifestations, and treatment of OLP. Results: OLP's pathogenesis is driven by immune dysregulation, with CD4+ and CD8+ cells playing crucial roles. Clinically, OLP presents as reticular, erosive, bullous, and plaque-like lesions. Diagnosis relies on clinical examination, histopathology, and direct immunofluorescence. Recent advancements in diagnostic markers and imaging techniques have improved detection and monitoring. Treatment primarily involves corticosteroids, but novel therapies such as curcumin, retinoids, and laser therapy are increasingly used for their effectiveness and reduced side effects. These treatments show promise in symptom reduction and recurrence prevention, although long-term data are needed. Conclusions: Regular screenings and biopsies are essential due to OLP's likelihood of malignant transformation. This study urges further investigation into long-term results, improved diagnostic techniques, and evidence-based treatment regimens.

Role of Vitamin D in Oral Lichen Planus: A Case Control Study

BACKGROUND

It has been reported that vitamin D deficiency may be associated with the development of oral lichen planus (OLP). Given the high prevalence of vitamin D deficiency in many countries, we sought to determine whether it constitutes a comorbidity of OLP.

METHODS

One hundred and twenty patients clinically and histologically diagnosed with OLP were evaluated for their serum vitamin D levels. The results were compared to results from a control series of the same number of subjects matched for age and sex.

RESULTS

Vitamin D deficiency was diagnosed in 45% (n = 54) of OLP patients and in 26.7% (n = 32) of the control group. Vitamin D supplements were being taken by 32 (26.7%) OLP patients and 15 (12.5%) subjects in the control group. A multivariate logistic regression model showed that OLP was associated with vitamin D deficiency [OR: 2.24 (1.28-3.98, p = 0.005)] and vitamin D supplementation [OR: 2.51 (1.25-5.22, p = 0.011)], even after controlling for confounding variables such as sex, age ≤60>, tobacco, and alcohol.

CONCLUSION

The association between OLP patients and vitamin D deficiency or vitamin D supplementation suggests that further research might explore the benefits of vitamin D supplements in managing OLP patients.

Network pharmacology and molecular docking analysis predict the mechanisms of Huangbai liniment in treating oral lichen planus

This study explored the mechanism of Huangbai liniment (HB) for the treatment of oral lichen planus (OLP) through network pharmacology and molecular docking techniques. The study identified HB' active ingredients, therapeutic targets for OLP, and associated signaling pathways. The chemical composition of HB was screened using the HERB database. The disease targets of OLP were obtained through the GeneCards and OMIM databases. A protein-protein interactions network was constructed with the String platform. Topological analysis was performed using Cytoscape software to identify core targets. Gene ontology and Kyoto encyclopedia of genes and genomes pathway enrichment analysis were performed using the Hiplot database, and the active ingredients and core targets were verified by molecular docking. Date analysis showed that the active composition of HB in the treatment of OLP were quercetin, wogonin, kaempferol, and luteolin. This survey identified 10 potential therapeutic targets, including TNF, CXCL8, IL-6, IL1B, PIK3R1, ESR1, JUN, AKT1, PIK3CA, and CTNNB1. Molecular docking revealed stable interactions between OLP' key targets and HB. These key targets were predominantly involved in the PI3K-Akt signaling pathway, AGE-RAGE signaling pathway, TNF signaling pathway, and HIF-1 signaling pathway. HB plays a crucial role in the treatment of OLP, acting on multiple targets and pathways, particularly the PI3K-Akt signaling pathway. It regulated biological processes like the proliferation of epithelial cells and lymphocytes and mediates the expression of transcription factors, cytokines, and chemokines. Therefore, this study provides a theoretical basis for the clinical trial and application of HB in the therapy of OLP.

B Cells Infiltration Potentially Responded Better to Systemic Corticoids in Oral Lichen Planus and Oral Lichenoid Lesions

Oral lichen planus (OLP) and oral lichenoid lesion (OLL) are chronic inflammatory diseases involving the oral mucosa. B cells infiltration in OLP and OLL, however, little is known about these cells in OLP and OLL. To analyze the function and infiltrating features of B lymphocytes in OLP and OLL, and to preliminarily evaluate their correlation with clinical outcomes. Tissue samples were collected from OLP, OLL, and healthy mucosa. The phenotypes and amounts of B cells in tissues were analyzed by single-cell sequencing. Their proportion and infiltrating features in tissues were examined by immunohistochemistry and immunofluorescence. With the systemic medication of corticoids, the correlation between B cells infiltrating characteristics and the clinical outcomes were evaluated. A quantified proportion increase of B cells was shown in both OLP and OLL. B cells in OLP demonstrated heightened activation and enhanced regulation in immune response. A cohort of 100 patients with OLP/OLL and 13 healthy controls were examined to investigate the B cells infiltration pattern. B cells were distributed in the superficial layer of lamina propria in 92.9% and 41.9% of OLP and OLL, respectively(P < 0.01); focally distributed in 25.0% and 62.9% of OLP and OLL, respectively(P < 0.01). With the systemic medication of corticoids, the cases with B cell infiltration (B+) in OLP and OLL groups showed a statistically significant reduction in REU scores before and after treatment (P < 0.01). B cells are widely present in OLP and OLL, and B cell infiltration in OLP and OLL are related to the better therapeutic effect of oral corticoids.

Differential Diagnosis of Pigmented Lesions in the Oral Mucosa: A Clinical Based Overview and Narrative Review

This paper examines the clinical differentiation of pigmented lesions in the oral mucosa, which poses significant diagnostic challenges across dental and medical disciplines due to their spectrum from benign to potentially malignant conditions. Through a literature review and analysis of clinical cases, this study clarifies current diagnostic methodologies, with an emphasis on differential diagnosis, to provide a practical guide for clinicians. The classification of pigmented lesions, such as endogenous, focal melanocytic, and multifocal pigmentation, based on clinical and histological features, highlights the necessity for a structured and informed approach. A retrospective examination of cases from our oral medicine and pathology clinic, coupled with analysis of photographic and histological records, aids in classifying these lesions. This fosters a better understanding and promotes informed discussions among clinicians, ultimately aiming to enhance early and precise diagnosis, thus improving patient management and outcomes.

A cytomics-on-a-chip platform and diagnostic model stratifies risk for oral lichenoid conditions

OBJECTIVE

A small fraction of oral lichenoid conditions (OLC) have potential for malignant transformation. Distinguishing OLCs from other oral potentially malignant disorders (OPMDs) can help prevent unnecessary concern or testing, but accurate identification by nonexpert clinicians is challenging due to overlapping clinical features. In this study, the authors developed a 'cytomics-on-a-chip' tool and integrated predictive model for aiding the identification of OLCs.

STUDY DESIGN

All study subjects underwent both scalpel biopsy for histopathology and brush cytology. A predictive model and OLC Index comprising clinical, demographic, and cytologic features was generated to discriminate between subjects with lichenoid (OLC+) (N = 94) and nonlichenoid (OLC-) (N = 237) histologic features in a population with OPMDs.

RESULTS

The OLC Index discriminated OLC+ and OLC- subjects with area under the curve (AUC) of 0.76. Diagnostic accuracy of the OLC Index was not significantly different from expert clinician impressions, with AUC of 0.81 (P = .0704). Percent agreement was comparable across all raters, with 83.4% between expert clinicians and histopathology, 78.3% between OLC Index and expert clinician, and 77.3% between OLC Index and histopathology.

CONCLUSIONS

The cytomics-on-a-chip tool and integrated diagnostic model have the potential to facilitate both the triage and diagnosis of patients presenting with OPMDs and OLCs.

Hypomethylation-associated Sox11 upregulation promotes oncogenesis via the PI3K/AKT pathway in OLP-associated OSCC

Oral lichen planus (OLP) is a particularly prevalent oral disorder with the potential to progress to oral squamous cell carcinoma (OSCC). SRY-box transcription factor 11 (Sox11) has been reported to serve as a prognostic marker for various cancers. However, the role and mechanism of Sox11 in OLP-related OSCC are unknown. Our results indicated that Sox11 was highly expressed, and that Sox11 promoter methylation was significantly reduced in OLP-associated OSCC tissues. High Sox11 expression and Sox11 promoter hypomethylation indicate a poor patient prognosis. According to in vivo and in vitro experiments, the knockdown of Sox11 inhibited proliferation, invasion, and migration while driving its apoptotic death in OSSC cells; Sox11 overexpression exerted the opposite effect as Sox11 knockdown. Mechanistically, knockdown of Sox11 inhibited PI3K/AKT and glycolysis pathway, and overexpression of Sox11 enhanced the PI3K/AKT and glycolysis pathways in OSCC cells. In addition, we demonstrated that Sox11 overexpression accelerated the progression of OSCC, at least in part by promoting PI3K/AKT pathway activation. In conclusion, our data indicated that the DNA hypomethylation-associated upregulation of Sox11 could promote oncogenic transformation via the PI3K/AKT pathway in OLP-associated OSCC. Therefore, Sox11 might be a reliable biomarker for predicting the progression of precancerous oral tissues.

Menopause and Oral Health: Clinical Implications and Preventive Strategies

Menopause, occurring typically between the ages of 45 and 55 years, marks the end of a woman's reproductive years and is characterized by the cessation of menstruation and a significant decline in estrogen and progesterone production. These hormonal changes impact various aspects of health, including oral health. This review explores the clinical implications of menopause on oral health and outlines preventive strategies. Hormonal changes during menopause can lead to xerostomia (dry mouth), periodontal disease, burning mouth syndrome (BMS), oral mucosal changes, altered taste sensation, and osteoporosis-related oral health issues. Xerostomia results from decreased salivary flow, increasing the risk of dental caries and oral infections. Periodontal disease is exacerbated by estrogen deficiency, leading to bone loss and increased tooth mobility. BMS, characterized by a chronic burning sensation, and oral mucosal atrophy are linked to hormonal fluctuations. In addition, altered taste perception and osteoporosis further complicate oral health management. Effective prevention and management strategies include regular dental checkups, good oral hygiene practices, and tailored treatments such as fluoride treatments, saliva substitutes, and hormone replacement therapy. Nonpharmacological approaches such as stress management and lifestyle modifications also play a role. This review emphasizes the importance of a multidisciplinary approach, involving dental and medical professionals, to address the complex oral health challenges faced by menopausal women. Understanding the underlying mechanisms and implementing evidence-based preventive measures can significantly enhance the oral health and overall well-being of menopausal women.

The Clinical Behavior and Recurrence Patterns of Oral Cavity Cancer in Oral Lichen Planus Patients

OBJECTIVES

Oral lichen planus (OLP) is a chronic inflammatory disorder involving epithelia with squamous differentiation. Although described as a potential malignant precursor, the characteristics of malignancies arising among these patients are not widely described. Our goal was to describe the patterns of disease recurrence of patients with oral cavity squamous cell carcinoma (OSCC) arising on the background of OLP.

METHODS

A retrospective analysis of all surgically treated patients with OSCC at a university-affiliated tertiary care center between 2000 and 2020.

RESULTS

Two hundred seventy-nine patients with OSCC treated surgically were included. Forty (14.3%) had OLP. The mean age of patients with OLP was 70.9 years compared with 64.3 years for non-OLP patients (p = 0.03). OLP patients had a significantly higher rate of disease recurrence, persistence, or multiple primary disease (70% vs. 33.9%, p < 0.001). The mean number of sequential oncologic events for each patient with recurrence was also significantly higher among OLP patients (1.86 vs. 1.36, p = 0.03), a difference explained by a higher rate of multiple primary presentations (0.71 vs. 0.28, p = 0.008). A significant difference in disease-free survival (DFS) was demonstrated between the groups as patients with OLP had a lower 5-year DFS (34.7% vs. 61.3%, log-rank p value <0.001). On multivariate analysis, OLP was significantly associated with multiple primary events (p < 0.001, Odds ratio = 7.42, 95% confidence interval 2.9-19).

CONCLUSIONS

OSCC patients with OLP background demand close clinical follow-up, as multiple primary disease is significantly more common and the DFS is significantly lower among these patients. A thorough clinical evaluation for all oral cavity subsites is mandatory.

LEVEL OF EVIDENCE

3 Laryngoscope, 134:3146-3151, 2024.

Human Papillomavirus in Oral Lichen Planus: Is There an Association? A Meta-Analysis

Lichen planus (LP) is a chronic, recurrent mucocutaneous inflammatory disease with unclearly defined etiology, where a potential role of several viruses has been considered. This meta-analysis aimed to determine the potential association between HPV and oral LP based on case-control and cross-sectional study results. A systematic search was performed in PubMed, Web of Science (SCI), Google Scholar, and Scopus databases with the last update on 6 March 2024. Pooled data were analyzed by calculating odds ratios (OR) and 95% confidence intervals (CI) with the metafor package for R. A total of 13 studies on 541 cases and 413 controls were included in this meta-analysis. It covered eight countries: India, Iran, Turkey, Czech Republic, Hungary, Italy, Macedonia, and the UK. In seven papers, the differentiation into the erosive-atrophic type and non-erosive-atrophic type of OLP was utilized. HPV infection was associated with at least a two times higher risk for a person with HPV to have OLP, depending on whether original data or filled/trimmed data were used. The OR values were 3.54 [2.01, 6.24] and 2.10 [1.16, 3.82], respectively. This meta-analysis was performed to identify the association between HPV and OLP and revealed that HPV infection was associated with at least a high risk for a person with HPV to develop OLP.

Comparison of autologous platelet concentrates and topical steroids on oral lichen planus: a systematic review and meta-analysis

BACKGROUND

Oral lichen planus is a chronic and potentially malignant disorder of oral mucosa. Corticosteroids are used as first-line therapy for oral lichen planus patients; however, they have many side effects. Platelet concentrates (platelet-rich plasma and platelet-rich fibrin) are autologous bioactive materials. This systematic review investigated the effects of autologous platelet concentrates compared to topical steroids in treating symptomatic oral lichen planus patients.

MATERIALS AND METHODS

A systematic literature search was performed in PubMed, Web of Science, Scopus, Embase, and Cochrane for randomized controlled trials. Preferred Reporting Items for Systematic Reviews and meta-analysis guidelines were observed for article selection. For the pooling of studies, meta-analysis using Standardized Mean Differences by random effects model was carried out to estimate summary effect sizes for the treatment of oral lichen planus.

RESULTS

A total of six studies, incorporating 109 oral lichen planus patients, were involved. Both treatment modalities showed a statistically significant improvement in the outcome parameters (lesion size, pain score, Thongprasom score) from the baseline to the end of treatment and further to the follow-up visits. There was no significant difference in the pooled estimate SMD of pain decline in patients of the two groups (SMD = 0.17 (95% CI: -0.47 to 0.81); I2 = 63.6%). The SMD of Thongprasom score in patients receiving autologous platelet concentrates was lower than the corticosteroid groups, with no significant effect size (SMD= -2.88 (95% CI: -5.51 to -0.25); I2 = 91.7%). Therefore, there was no statistically significant difference between the autologous platelet concentrates and topical steroids regarding pain and clinical score.

CONCLUSION

Autologous platelet concentrates, and topical steroids decreased the size of lesions, Thongprasom scale, and pain in oral lichen planus patients, but the difference between the two treatments was not statistically significant. Thus, autologous platelet concentrates could be considered as an alternative treatment to topical steroids.

Oral and non-oral lichen planus show genetic heterogeneity and differential risk for autoimmune disease and oral cancer

Lichen planus (LP) is a T-cell-mediated inflammatory disease affecting squamous epithelia in many parts of the body, most often the skin and oral mucosa. Cutaneous LP is usually transient and oral LP (OLP) is most often chronic, so we performed a large-scale genetic and epidemiological study of LP to address whether the oral and non-oral subgroups have shared or distinct underlying pathologies and their overlap with autoimmune disease. Using lifelong records covering diagnoses, procedures, and clinic identity from 473,580 individuals in the FinnGen study, genome-wide association analyses were conducted on carefully constructed subcategories of OLP (n = 3,323) and non-oral LP (n = 4,356) and on the combined group. We identified 15 genome-wide significant associations in FinnGen and an additional 12 when meta-analyzed with UKBB (27 independent associations at 25 distinct genomic locations), most of which are shared between oral and non-oral LP. Many associations coincide with known autoimmune disease loci, consistent with the epidemiologic enrichment of LP with hypothyroidism and other autoimmune diseases. Notably, a third of the FinnGen associations demonstrate significant differences between OLP and non-OLP. We also observed a 13.6-fold risk for tongue cancer and an elevated risk for other oral cancers in OLP, in agreement with earlier reports that connect LP with higher cancer incidence. In addition to a large-scale dissection of LP genetics and comorbidities, our study demonstrates the use of comprehensive, multidimensional health registry data to address outstanding clinical questions and reveal underlying biological mechanisms in common but understudied diseases.

Efficacy and safety of topical clobetasol propionate in comparison with alternative treatments in oral lichen planus: an updated systematic review and meta-analysis

Background

Oral lichen planus (OLP) is a relatively common chronic T cell-mediated disease characterized by pain and inflammation. Clobetasol propionate (CLO) is the first-line drug in the treatment of OLP. The meta-analysis aimed to evaluate the efficacy and safety of CLO for treating patients with OLP.

Methods

PubMed, Embase and Web of Science were systematically searched from the database inception date up to August 2023. There were no restrictions on language or date of publication. The outcomes of our interest were as follows: improvement of clinical signs and/or symptoms, total lesion size, relapse and adverse events.

Results

A total of 17 RCTs evaluating the effects of CLO were included in this study. The results revealed no significant difference in the clinical score (WMD = 0.14, 95% CI: -0.39, 0.66; p = 0.609) and pain score (WMD = 0.17, 95% CI: -0.44, 0.79; p = 0.582) between CLO and other treatments. However, clinical resolution (RR = 1.61, 95% CI: 1.17, 2.22; p = 0.003) and symptoms improvement (RR = 1.80, 95% CI: 1.17, 2.77; p = 0.008) were significantly different between CLO and other treatments. Moreover, there was a significant reduction in the total lesion size with CLO treatment (WMD = -0.58, 95% CI: -1.03, -0.13; p = 0.011). In addition, CLO showed no statistical incidence of adverse events (RR = 1.46, 95% CI: 0.86, 2.50; p = 0.161) and relapse (RR = 1.56, 95% CI: 0.66, 3.71; p = 0.314) than other therapies.

Conclusion

This systematic review and meta-analysis of 17 randomized clinical trials supported the long-term application of CLO as an effective regimen in OLP patients.

Factors involved in the remission of oral lichen planus treated with topical corticosteroids

AIM

To determine the factors that affected the complete clinical remission of oral lichen planus (OLP) treated with topical corticosteroids.

MATERIAL AND METHODS

We retrospectively evaluated the charts of patients diagnosed as OLP. Age, sex, current medical conditions, medications, type of OLP, Thongprasom score, pain level assessed by a numeric rating scale (NRS), Candida infection, topical steroid treatment preparation, duration of treatment until the first complete clinical remission, and follow-up duration were assessed as variables.

RESULTS

In total 100 patients, after complete remission, 22 patients reported a relapse within 1.5-45 months, with a mean of 15.6 ± 13.2 months. Age, duration, gingiva and vestibule area, hypertension, dyslipidemia, Thongprasom score, preparation and topical corticosteroid potency were factors affecting the remission. Multivariate logistic regression analysis revealed that the patients' age and duration of treatment were significant factors after adjusted for age, sex, and independent factors with a P-value < 0.1 in the univariate analysis. The likelihood of having incomplete remission of the OLP lesion increased by 7.9% for every year increase in age and increased by 2.3% for every month of treatment.

CONCLUSIONS

There are many different factors between the complete remission and incomplete remission groups. However, age and duration of treatment were significant factors affecting the remission of OLP.

Salivary and serum estrogen level assessment in oral lichen planus patients and its correlative analysis with OLP and stress

Background

Lichen planus is a chronic inflammatory disease of the skin and mucous membrane with higher predilection seen in the female population. Oral lichen planus (OLP) has been associated with various etiological factors, such as stress, hormonal imbalance, and immunological variation. The purpose of this study was to assess serum and salivary estrogen (E2) levels in OLP patients and correlate them with stress levels.

Objectives

This study aimed to evaluate serum and salivary estrogen levels in female patients with OLP, along with the assessment of stress and its correlation with estrogen levels.

Methods

A total of 78 females, 39 clinically diagnosed with OLP and 39 healthy females, were included in the study as the case and control groups, respectively. 2 ml each of salivary and serum samples was obtained from each participant to measure the estrogen levels. Stress levels in the study group patients were assessed using the Depression Anxiety Stress Scale (DASS-21) and the Perceived Stress Scale (PSS). The nonparametric Mann-Whitney test was used for intergroup comparisons.

Results

Significantly higher serum estrogen levels with higher DASS-21 and PSS scores were noted in patients with OLP. Overall, significant positive correlations were observed between salivary E2 and serum E2 (r = 0.361, P = 0.001). There was a positive correlation between salivary and serum E2 and DASS score (r = 0.410, P < 0.001, and r = 0.768, P < 0.001, respectively), serum/salivary E2 and PSS score (r = 0.745, P < 0.001, and r = 0.410, P < 0.001, respectively), and DASS score and PSS score (r = 0.878, P < 0.001).

Conclusion

Estrogen can be used as a useful biomarker for OLP in the future. Salivary samples can prove to be an accurate and feasible alternative to serum estrogen level determination. We also suggest that OLP patients must be given supportive psychological treatment for improved life quality and disease management.

PA28γ induces dendritic cell maturation and activates T-cell immune responses in oral lichen planus

Oral lichen planus (OLP) is a common chronic inflammatory disease of the oral mucosa, the mechanism of its inflammatory progression has not yet been fully elucidated. PA28γ plays a significant role in a variety of immune-related diseases. However, the exact role of PA28γ in the pathogenesis of OLP remains unclear. Here, we demonstrated that PA28γ is overexpressed in epithelial cells and inflammatory cells of OLP tissues but has no significant relationship with OLP subtypes. Functionally, keratinocytes with high PA28γ expression could induce dendritic cell (DC) maturation and promote the T-cell differentiation into Th1 cells in response to the immune response. In addition, we found that a high level of PA28γ expression is associated with high numbers of infiltrating mature DCs and activated T-cells in OLP tissues. Mechanistically, keratinocytes with high PA28γ expression could promote the secretion of C-C motif chemokine (CCL)5, blocking CCL5 or/and its receptor CD44 could inhibit the induction of T-cell differentiation by keratinocytes with high PA28γ expression. In conclusion, we reveal that keratinocytes with high expression of PA28γ in OLP can induce DC maturation and promote T-cell differentiation through the CCL5-CD44 pathway, providing previously unidentified mechanistic insights into the mechanism of inflammatory progression in OLP.

Potential implication of serum lipid levels as predictive indicators for monitoring oral lichen planus

Compelling evidence indicates that dyslipidemia is positively associated with oral lichen planus (OLP). The types and magnitude of lipid metabolism disturbance in peripheral blood of OLP patients have been investigated in different studies. Yet, consensus on how these different lipid components varied in levels for the development of OLP lesions has not been reached so far. Herein, a total of 8 eligible studies were recognized, which enrolled 533 cases of OLP and 499 healthy controls. The analysis showed that the average total triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) levels were considerably higher, and high-density lipoprotein cholesterol (HDL-C) levels were significantly lower in OLP patients compared to healthy controls. Collectively, the lipid profile panel maybe serve as the potential predictive indicator for screening OLP.

Hydroxychloroquine for the management of recalcitrant oral lichen planus

OBJECTIVE

The objective of this study is to describe the efficacy of hydroxychloroquine (HCQ) in patients with oral lichen planus (OLP) refractory to conventional therapy.

STUDY DESIGN

In this single-center retrospective study, patients were prescribed HCQ 200 mg twice daily. Pain, reticulation, erythema, and ulceration scores were recorded. Two-sample and paired t tests were used to evaluate mean and paired pain scores and paired t test to determine substantial differences in paired REU scores, at HCQ initiation visit and final follow-up at 12 to 24 months.

RESULTS

Thirty-six patients (69.4% female) with a median age of 70 ± 12.0 (range 48-99) were initiated on HCQ. Only 30 patients were evaluable because pruritus developed in 5 patients (13.9%) and gastrointestinal symptoms in 1 (2.8%). The mean follow-up was 23.2 months (range 1-74). In 19 patients, there was a significant decline in the worst pain score from a mean of 3.9 (SD± 2.8, n = 19) to 1.9 (SD ± 2.4, n = 19) (t = 2.837, P < .006). Paired reticulation, erythema, and ulceration (REU scores) decreased from a weighted mean score of 16.0 (SD ± 8.0, n = 12) to 12.0 (SD ± 6.3, n = 12) (t = 2.07, P < .032).

CONCLUSION

Hydroxychloroquine was a suitable option and effective in reducing symptoms and disease severity in patients with recalcitrant OLP who do not adequately respond to standard therapy.

Efficacy and safety of gut microbiota-based therapies in autoimmune and rheumatic diseases: a systematic review and meta-analysis of 80 randomized controlled trials

BACKGROUND

Previous randomized controlled trials (RCTs) suggested that gut microbiota-based therapies may be effective in treating autoimmune diseases, but a systematic summary is lacking.

METHODS

Pubmed, EMbase, Sinomed, and other databases were searched for RCTs related to the treatment of autoimmune diseases with probiotics from inception to June 2022. RevMan 5.4 software was used for meta-analysis after 2 investigators independently screened literature, extracted data, and assessed the risk of bias of included studies.

RESULTS

A total of 80 RCTs and 14 types of autoimmune disease [celiac sprue, SLE, and lupus nephritis (LN), RA, juvenile idiopathic arthritis (JIA), spondyloarthritis, psoriasis, fibromyalgia syndrome, MS, systemic sclerosis, type 1 diabetes mellitus (T1DM), oral lichen planus (OLP), Crohn's disease, ulcerative colitis] were included. The results showed that gut microbiota-based therapies may improve the symptoms and/or inflammatory factor of celiac sprue, SLE and LN, JIA, psoriasis, PSS, MS, systemic sclerosis, Crohn's disease, and ulcerative colitis. However, gut microbiota-based therapies may not improve the symptoms and/or inflammatory factor of spondyloarthritis and RA. Gut microbiota-based therapies may relieve the pain of fibromyalgia syndrome, but the effect on fibromyalgia impact questionnaire score is not significant. Gut microbiota-based therapies may improve HbA1c in T1DM, but its effect on total insulin requirement does not seem to be significant. These RCTs showed that probiotics did not increase the incidence of adverse events.

CONCLUSIONS

Gut microbiota-based therapies may improve several autoimmune diseases (celiac sprue, SLE and LN, JIA, psoriasis, fibromyalgia syndrome, PSS, MS, T1DM, Crohn's disease, and ulcerative colitis).

Case Report: Recalcitrant oral lichen planus involving bilaterally buccal mucosae treated with a combination of photodynamic and photobiomodulation therapies

Background

Managing recalcitrant oral lichen planus (OLP) can be challenging. Laser therapy has been suggested as an alternative to corticosteroids for treatment. Photodynamic therapy (PDT) is a non-invasive technique that enables the removal of lesions without surgery. Photobiomodulation therapy (PBMT) can promote healing and recovery of the lesions.

Case presentation

The objective was to treat unresponsive bilateral OLP of the whole buccal mucosae with a combination of PDT and PBMT.

Results

A 43-year-old Thai male presented with the severe painful reticular type of OLP of bilateral buccal mucosae involving upper and lower vestibular areas. The lesions were not remitted with either prednisolone systemic steroids or fluocinolone topical corticosteroids. After undergoing ten sessions of PDT with 10% 5-Aminolevulinic acid (5-ALA) in the form of thermoplastic gel and a 635 nm diode laser at 100 to 400 mW with an energy density of 20 to 30 J/cm 2 in continuous wave mode, combined with five interim-sessions of PBMT using a 635 nm diode laser at 200 to 300 mW with an energy density of 6 to 10 J/cm 2 in continuous wave, the patient reported relief of burning sensation beside remission of lesions without any complications.

Conclusion

The wide-spreading recalcitrant OLP with burning sensation can be managed by combining PDT and PBMT.

What can we learn from treatments of oral lichen planus?

Oral lichen planus (OLP), a T-lymphocyte-mediated disease of the oral mucosa, has a complex pathogenesis that involves a number of factors. The disease is characterized by recurrent episodes and requires continuous follow up, and there is no curative treatment available. Erosive lichen planus, among others, has a risk of malignant transformation and requires standardized treatment to control its progression. Different clinical subtypes of oral lichen planus require appropriate treatment. Pharmacological treatments are the most widely available and have the greatest variety of options and a number of novel pharmacological treatments are presented as highlights, including JAK enzyme inhibitors. The second is photodynamic therapy, which is the leading physiological treatment. In addition, periodontal treatment and psychological treatment should not be neglected. In this review, we briefly discuss the most recent developments in therapies for oral lichen planus after summarizing the most widely used clinical treatments, aiming to provide different proposals for future clinical treatment.

Survival of dental implants and occurrence of mucosal overgrowth in patients with head and neck cancer treated with/without radiotherapy and mucosal graft-two-year follow-up

OBJECTIVES

The primary aim of the present study was to compare head and neck cancer treatment modality surgery and surgery with radiotherapy or chemoradiotherapy alone for dental implant (DI) survival. The second aim was to evaluate the prevalence of mucosal overgrowth around DI after treatment with or without mucosal grafts.

MATERIALS AND METHODS

An observational retrospective study consisted of 59 patients with malignant head and neck tumors that received DI between 2015 and 2019. Treatment modalities together with information on oral rehabilitation with DI, prevalence of mucosal overgrowth, and precursor lesions were gathered from the hospital records. Radiation doses were determined using a sum of three-dimensional dose distributions.

RESULTS

Overall DI survival rate was 88%, in irritated jaw 89%, and in nonirradiated jaw 88% in this observational period (p = 0.415, mean follow-up was 2 years 10 months, range 9-82 months). Mucosal overgrowth was found in 42 of 196 implants (21%), of which 36 cases (86%) were associated in grafted areas (p < 0.001). Oral lichen planus/lichenoid reaction was diagnosed in 14 of all 59 (24%) oral cancer patients.

CONCLUSION

Implant survival was not significantly influenced by radiation therapy in this observational period. In grafted bone, implant survival was significantly inferior than in native bone. Mucosal overgrowth around implants was more common in mucosal grafted areas versus nongrafted.

CLINICAL RELEVANCE

This study demonstrates the impact of grafted bone to dental implant survival rate and mucosal overgrowth.

Dynamic changes of Th1/Th2/Th17 cytokines and hBD-2/3 in erosive oral lichen planus patients saliva before and after prednisone acetate treatment

Objective

This study aimed to investigate the expression of T helper 1 (Th1)/Th2/Th17- related cytokines and human beta defensins 2 and 3 (hBD-2 and -3) in the saliva of patients with erosive oral lichen planus (EOLP) and to explore their role in the pathogenesis of EOLP and the effects of glucocorticoids on EOLP.

Methods

A total of 30 patients with EOLP and 20 age- and sex-matched healthy individuals were included in this study. The patients were treated with prednisone at a dose of 0.4 mg/(kg·d) for 1 week and examined before and after treatment. Unstimulated whole saliva samples were collected to determine the levels of cytokines (interleukin 1 beta [IL-1β], tumour necrosis factor alpha [TNF]-α, interferon gamma [IFN-γ], IL-4, IL-6, IL-10 and IL-17) by cytometric bead array and those of hBD-2 and -3 b y enzyme-linked immunosorbent assay. In addition, oral rinse samples were collected to detect Candida load.

Results

The levels of salivary IL-1β, IL-6, hBD-2 and hBD-3 were higher and the IFN-γ/IL-4 and IL-1β/IL-6 ratios were lower in patients with EOLP than in healthy individuals. In patients with EOLP, hBD-2 levels were positively correlated with IFN-γ levels and negatively correlated with IL-17 levels, whereas hBD-3 levels were negatively correlated with IL-17 and IL-10 levels. In addition, the prevalence of EOLP was positively correlated with IL-6 levels and negatively correlated with the IFN-γ/IL-4 ratio. The levels of IL-1β, TNF-α, IFN-γ, IL-6, hBD-2 and hBD-3 and the IFN-γ/IL-4 ratio decreased after treatment with prednisone for 1 week. The levels of IL-6, hBD-2 and hBD-3 were significantly higher in EOLP patients than in healthy individuals; while TNF-α levels and the IFN-γ/IL-4 ratio were significantly lower in EOLP patients than in healthy individuals. Furthermore, the oral counts of Candida spp. (colony forming unit [CFU]) were negatively correlated with TNF-α levels. Numerical Rating Scale(NRS) and Sign scores decreased in EOLP patients after treatment. Approximately 80 % of patients were effectively treated. Salivary TNF-α levels were significantly higher in the treatment-ineffective group than in the treatment-effective group before treatment with prednisone, and differences in salivary IL-6 levels before and after treatment were significantly higher in the treatment-effective group than in the treatment-ineffective group.

Conclusions

High expression of IL-1β, IL-6, hBD-2 and Th1/Th2 imbalance in saliva may be associated with the pathogenesis of EOLP. IFN-γ/IL-4 balance may serve as a protective factor for EOLP. Glucocorticoids significantly alleviate the symptoms of EOLP and inhibit the expression of Th1/Th2 cytokines.

Diagnostic Infrared Thermography of the Tongue and Taste Perception in Patients with Oral Lichen Planus: Case-Control Study

Oral lichen planus (OLP) is a chronic inflammatory disease of autoimmune origin that affects the skin and mucous membranes. The aim of this study was to assess the effectiveness of infrared thermography (IRT) as a diagnostic tool in patients with oral lichen planus (OLP), as well as disturbances in taste perception, in cases with and without tongue involvement. A case-control study was carried out in a sample of 87 patients divided into three groups: healthy individuals (controls; n = 43), OLP patients without involvement of the tongue (n = 24), and OLP patients with involvement of the tongue (n = 20). The patient symptoms and the clinical characteristics of the lesions were assessed. Four thermal images of the tongue were obtained using IRT: dorsum, right and left lateral surface, and tip of the tongue. General taste perception capacity and subjective sweet, acid, salty, and bitter sensation were evaluated in all three groups. There were no statistically significant differences in the IRT values among the three groups (p ≥ 0.05). In the OLP patients with involvement of the tongue, significantly higher values were observed in the mixed forms of the disease (p = 0.032). The OLP patients with and without involvement of the tongue showed no significant alterations in taste sensation (p = 0.69). IRT may serve as a complementary tool for assessing the activity of OLP with involvement of the tongue. However, more research is needed in this field.

Effectiveness of Injectable Platelet-Rich Fibrin in the Treatment of Oral Lichen Planus: A Systematic Review and Meta-Analysis

Oral lichen planus (OLP) is a chronic inflammatory condition affecting the oral mucosa. The current review investigated the potential effectiveness of injectable platelet-rich fibrin (i-PRF) as a treatment for OLP when compared to other interventions. The current review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search strategy was implemented across databases such as PubMed, Embase, Scopus, Web of Science, CINAHL, and Google Scholar. The search utilized a combination of Boolean operators (AND, OR) and Medical Subject Headings (MeSH) terms to capture relevant studies. Comparative clinical studies focusing on i-PRF as a treatment for OLP and other interventions were included. Outcomes assessed were pain, surface area of lesions, and patient satisfaction. Review Manager 5.4 was used for statistical analysis. The Risk of Bias 2.0 (RoB 2.0) tool was used to assess the methodological quality of the studies. Three studies were included for the final analysis. The findings indicated that both the i-PRF and comparison treatment groups demonstrated reductions in pain and lesion size. The post-treatment Visual Analogue Scale (VAS) scores showed a decrease in pain intensity, and there was an improvement in lesion extension in the i-PRF-treated sites. The results also revealed increased patient satisfaction with i-PRF treatment. Adverse effects were not reported or specified in the included studies. Quantitative analysis for pain (VAS) showed a mean difference of 0.38 (95% CI: 0.63-1.40), but there was no significant difference between the i-PRF and control groups at p=0.46. Though intragroup differences showed statistically significant differences between pre and post intervention, intergroup differences were not significant for any of the assessed outcomes. The findings from this study suggest that i-PRF holds promise as a potential treatment for OLP. The use of i-PRF resulted in pain reduction, lesion size improvement, and increased patient satisfaction. However, it is important to consider the limitations of the included studies, such as variability in study designs, small sample sizes, and the limited number of studies.

Platelet-rich fibrin in dentistry

OBJECTIVES

To review the progress of Platelet Rich Fibrin (PRF) as a biomaterial in dentistry and to highlight its promising application as a safe and biocompatible autologous platelet concentrate. Publications were searched in GeenMedical, X-mol, GoogleScholar, and PubMed from October 2024 with no language restrictions. The literature was searched for relevant databases and journals on the use of PRFs in dentistry up to October 2024, and the inclusion criteria included randomized controlled trials, clinical trials, case series, and systematic reviews.

CONCLUSION

PRF is a second-generation platelet concentrate that is sourced from oneself, has fewer adverse effects, and is simple and safe to prepare. These materials include growth factors and fibrin scaffolds, which are extensively utilized in regenerative medicine. By outlining PRF, we found that good results can be achieved when PRF is used to treat these conditions.

CLINICAL SIGNIFICANCE

The application of PRF in dentistry is widespread, particularly in periodontal soft and hard tissue regeneration, oral lichen planus, and pulpal regeneration. This article reviews the background, classification, and preparation methods of PRFs, along with their dental applications. We anticipate further research on various PRF derivatives in the future, which will significantly improve the utilization of PRF in oral applications and offer fresh insights for diagnosing and treating oral diseases.

Oral Lichen Planus: An Update on Diagnosis and Management

Oral lichen planus (OLP) is a chronic inflammatory disease whose pathogenesis involves a T-cell mediated, epithelium-directed inflammation in response to unknown antigen(s). The disease evolves by intermittent flares and displays polymorphous clinical features (reticular, erosive, atrophic, plaque, papular, bullous, etc.). When present, symptoms vary depending on the clinical form and range from discomfort to severe pain. Topical superpotent corticosteroids constitute the first-line treatment of symptomatic flares, whereas a wide range of second/third-line treatments are available among topical calcineurin inhibitors, systemic corticosteroids, systemic retinoids, topical/systemic immunomodulators, etc. Follow-up of patients is necessary to detect transformation into squamous cell carcinoma, occurring in approximately 1% of patients.

Crossroads between Skin and Endocrine Glands: The Interplay of Lichen Planus with Thyroid Anomalies

In this narrative review, we aimed to overview the interplay between lichen planus (LP) and thyroid conditions (TCs) from a dual perspective (dermatologic and endocrine), since a current gap in understanding LP-TC connections is found so far and the topic is still a matter of debate. We searched PubMed from Inception to October 2023 by using the key terms "lichen planus" and "thyroid", (alternatively, "endocrine" or "hormone"). We included original clinical studies in humans according to three sections: LP and TC in terms of dysfunction, autoimmunity, and neoplasia. Six studies confirmed an association between the thyroid dysfunction (exclusively hypothyroidism) and LP/OL (oral LP); of note, only one study addressed cutaneous LP. The sample size of LP/OLP groups varied from 12-14 to 1500 individuals. Hypothyroidism prevalence in OLP was of 30-50%. A higher rate of levothyroxine replacement was identified among OLP patients, at 10% versus 2.5% in controls. The highest OR (odd ratio) of treated hypothyroidism amid OLP was of 2.99 (p < 0.005). Hypothyroidism was confirmed to be associated with a milder OLP phenotype in two studies. A single cohort revealed a similar prevalence of hypothyroidism in LP versus non-LP. Non-confirmatory studies (only on OLP, not cutaneous LP) included five cohorts: a similar prevalence of hypothyroidism among OLP versus controls, and a single cohort showed that the subjects with OLP actually had a lower prevalence of hypothyroidism versus controls (1% versus 4%). Positive autoimmunity in LP/OLP was confirmed in eight studies; the size of the cohorts varied, for instance, with 619 persons with LP and with 76, 92, 105, 108, 192, 247, and 585 patients (a total of 1405) with OLP, respectively; notably, the largest control group was of 10,441 individuals. Four clusters of approaches with respect to the autoimmunity in LP/OLP were found: an analysis of HT/ATD (Hashimoto's thyroiditis/autoimmune thyroid diseases) prevalence; considerations over the specific antibody levels; sex-related features since females are more prone to autoimmunity; and associations (if any) with the clinical aspects of LP/OLP. HT prevalence in OLP versus controls was statistically significantly higher, as follows: 19% versus 5%; 12% versus 6%; and 20% versus 9.8%. A single study addressing LP found a 12% rate of ATDs. One study did not confirm a correlation between OLP-associated clinical elements (and OLP severity) and antibody values against the thyroid, and another showed that positive TPOAb (anti-thyroperoxidase antibodies) was more often found in erosive than non-erosive OLP (68% versus 33%). Just the reverse, one cohort found that OLP subjects had a statistically significantly lower rate of positive TPOAb versus controls (9% versus 15%). Five case-control studies addressed the issue of levothyroxine replacement for prior hypothyroidism in patients that were diagnosed with OLP (no study on LP was identified); three of them confirmed a higher rate of this treatment in OLP (at 8.9%, 9.7%, and 10.6%) versus controls. In conclusion, with regard to LP/OLP-TC, we note several main aspects as practical points for multidisciplinary practitioners: OLP rather than LP requires thyroid awareness; when it comes to the type of thyroid dysfunction, mostly, hypothyroidism should be expected; female patients are more prone to be associated with ATDs; a potential higher ratio of OLP subjects taking levothyroxine was found, thus a good collaboration with an endocrinology team is mandatory; and so far, OLP individuals have not been confirmed to be associated with a higher risk of thyroid nodules/cancer.

Bridging the gaps: management of lichen planus subtypes in a joint dermatology-oral surgery clinic

Lichen planus (LP) presents with a range of clinical subtypes. It can affect the outer skin, involve the nails and present with alopecia and mucosal symptoms to varying degrees. LP of the outer skin mostly shows a self-limiting course; however, this is not the case for lichen planopilaris and the mucosa-affecting subtypes. The pathogenesis of LP is still incompletely understood. As a result, an effective, targeted therapy is currently lacking and different immunomodulatory approaches are being used in clinical practice. The management of patients with severe oral LP mucosae can be particularly challenging. Although the true risk remains controversial, oral LP is considered a risk factor for the development of squamous cell carcinoma and there is a need for regular screening. The quality of life in patients with LP is significantly impaired because of frequent clinical visits, pain, soreness, inability to eat certain foods, side effects to medication, frustrating therapy attempts and worry regarding cancer risk. We highlight here the advantages of an interdisciplinary dermatology and oral surgery clinic, which can address the domains of tooth status, nutrition, pain and malignant transformation and optimized patient management.

Senescence-associated secretory phenotypes in mesenchymal cells contribute to cytotoxic immune response in oral lichen planus

Oral lichen planus is a chronic inflammatory condition that adversely affects the oral mucosa; however, its etiology remains elusive. Consequently, therapeutic interventions for oral lichen planus are limited to symptomatic management. This study provides evidence of the accumulation of senescent mesenchymal cells, CD8 + T cells, and natural killer cells in patients with oral lichen planus. We profiled the patients' tissues using the National Center for Biotechnology Information Gene Expression Omnibus database and found that senescence-related genes were upregulated in these tissues by gene set enrichment analysis. Immunohistochemical analysis showed increased senescent mesenchymal cells in the subepithelial layer of patients with oral lichen planus. Single-cell RNA-seq data retrieved from the Gene Expression Omnibus database of patients with oral lichen planus revealed that mesenchymal cells were marked by the upregulation of senescence-related genes. Cell-cell communication analysis using CellChat showed that senescent mesenchymal cells significantly influenced CD8 + T cells and natural killer cells via CXCL12-CXCR4 signaling, which is known to activate and recruit CD8 + T cells and NK cells. Finally, in vitro assays demonstrated that the secretion of senescence-associated factors from mesenchymal cells stimulated the activation of T cells and natural killer cells and promoted epithelial cell senescence and cytotoxicity. These findings suggest that the accumulation of mesenchymal cells with senescence-associated secretory phenotype may be a key driver of oral lichen planus pathogenesis.

Oral mucosal diseases and psychosocial factors: progress in related neurobiological mechanisms

The aetiology of oral mucosal diseases, such as recurrent aphthous ulcer (RAU), oral lichen planus (OLP) and burning mouth syndrome (BMS), involves many factors, and it remains difficult for clinicians to effectively relieve disease symptoms and formulate coping strategies. With the rapid development of psychology, the role of mental and psychological factors in RAU, OLP and BMS has gradually attracted researchers attention, but the specific mechanism has not been completely determined. This narrative review describes the potential neurobiological mechanism of oral mucosal diseases and detailed psychological factors after introducing relevant research into psychological factors and oral mucosal diseases. Future research strategies and innovations needed to understand and treat oral mucosal diseases and psychological factors, as well as how to prevent oral mucosal diseases by regulation of the neuroendocrine system, are also discussed.

Systemic non-steroidal immunomodulators for oral lichen planus treatment-a scoping review

OBJECTIVE

The aim of this scoping review was to evaluate the efficacy and safety of the use of systemic nonsteroidal immunomodulators (SNSI) for oral lichen planus (OLP) treatment.

MATERIALS AND METHODS

This review was conducted according to PRISMA-ScR guidelines and registered at PROSPERO (CRD42021243524). Consulted databases were Pubmed, Embase, Scopus, and Web of Science. The inclusion criteria was as follows: clinical trials, case series, prospective, and retrospective studies conducted with participants presenting OLP of any sex and age.

RESULTS

Thirty-two studies were selected, assessing 9 different SNSI: methotrexate, dapsone, levamisole, hydroxychloroquine, thalidomide, metronidazole, azathioprine, mycophenolate mofetil, and colchicine. Methotrexate and dapsone were the drugs with the best evidence among the options included, regarding number and quality of studies. Methotrexate resulted in significant improvement in the clinical condition and remission of symptoms, ranging between 63 and 93% of cases. Dapsone presented a similar effect to the use of topical corticosteroids and tacrolimus CONCLUSION: Among SNSI therapeutic options, methotrexate, and dapsone showed promising efficacy and safety. However, large-scale randomized clinical trials are still needed.

CLINICAL RELEVANCE

SNSI have been used in the treatment of recalcitrant OLP; however, so far, it is not clear which are the best options. This scoping review highlights the potential use of methotrexate and dapsone.

A retrospective cohort study of the efficacy of metronidazole in oral lichen planus

Lichen planus (LP) is an inflammatory dermatosis with mucosal variants, including oral LP (OLP). OLP has a relapsing chronic course and may significantly affect a patient's quality of life. We analysed the efficacy of metronidazole as a treatment for OLP via a retrospective chart review of patients with a diagnosis of OLP seen at our institution over 10 years. Thirty patients with OLP were treated with metronidazole 500 mg twice daily. Most patients (n = 18; 60%) showed improvement with metronidazole, including 10 (33%) who experienced complete resolution of symptoms. Our results were limited by the retrospective nature of the review and the relatively small cohort size. Given the efficacy, mild side-effect profile and the less immunosuppressive nature of metronidazole vs. alternative systemic treatment options, metronidazole is a reasonable option to try in patients with symptomatic OLP who have failed topical treatment options.

Contact sensitisation in oral lichen planus: An Australian perspective

BACKGROUND

The role of contact sensitisation in the pathogenesis of oral lichen planus (OLP) has not been clearly defined.

OBJECTIVE

We aimed to evaluate relevant contact sensitisers in OLP.

METHODS

A retrospective study was conducted on OLP patients who underwent patch testing from 1 January 2006 to 31 December 2020 at an Australian tertiary dermatology institution, compared to cheilitis patients patch tested over the same time period.

RESULTS

Ninety-six OLP patients and 152 cheilitis patients were patch tested during the 15-year period. Seventy-one (73.9%) OLP patients and 100 (65.8%) cheilitis patients recorded one or more relevant reactions. Forty-three (44.8%), 22 (22.9%), 21 (21.9%) and 17 (17.7%) OLP patients had relevant reactions to mercury-related chemicals, amalgam, spearmint and carvone, respectively, compared to 6 (3.9%), 3 (2.0%), 4 (2.6%) and 0 (0%) cheilitis patients, respectively (p-value <0.001 each). Four (4.2%) OLP patients had relevant positive reactions to sodium metabisulfite, compared to none in the cheilitis group (p-value 0.021).

CONCLUSION

While dental amalgam is used less frequently these days, we report that mercury (found in amalgam) and additionally spearmint and carvone are relevant sensitisers in OLP in Australia. Sodium metabisulfite may also be a relevant sensitiser in OLP, which has not previously been reported.

An exotic pathogenetic mechanism of angiogenesis in oral lichen planus-A systematic review

OBJECTIVE

Angiogenesis plays a vital role at the molecular level in various inflammatory lesions, that lead to their chronicity. Oral lichen planus is an immune-mediated chronic inflammatory disorder. The angiogenetic role and exact mechanisms in oral lichen planus are still unclear due to a dearth of studies. Its clinical significance with angiogenesis also requires further elucidation necessitating a thorough review of the studies that have been conducted so far. The present review was designed to identify the dependence of oral lichen planus progression on angiogenesis which could aid in devising metronomic treatments required to halt the progression of this disease.

MATERIALS AND METHODS

A thorough search was made using MEDLINE by PubMed, Scopus, Google scholar, Cochrane library, and EMBASE databases. Original research articles, that immunohistochemically evaluated angiogenesis in oral lichen planus were included for review. Risk of bias was analysed for each study using Modified Newcastle-Ottawa scale and Review Manager 5.4 was used to output its result.

RESULTS

Twenty-nine published articles were included for data synthesis. The most commonly employed antibody was CD34, however, upregulated VEGF expression was the principal while ICAM-1, VCAM-1, and PECAM-1 were critical angiogenic factors to mediate angiogenesis in oral lichen planus.

CONCLUSION

The current evidence supports that angiogenesis, a fundamental pathogenetic mechanism of oral lichen planus, leads to its persistence and chronicity. However, studies with a larger sample size, standard evaluation criteria, different subtypes, and adequate follow-up are warranted.