Oral Lichen Planus: An Update on Diagnosis and Management

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.

Association Between Autoimmune Thyroid disease and Oral Lichen Planus: A Multi-Omic Genetic Analysis

OBJECTIVE

The oral mucosa mirrors a range of latent systemic disorders, with potential clinical associations noted between autoimmune thyroid disease (AITD) and oral lichen planus (OLP). This study aims to explore the genetic relationship and underlying mechanisms mediating these conditions.

METHODS

A 2-step Mendelian randomization (MR) analysis was conducted to elucidate the genetic relationship and mediating factors between AITD and OLP. Linkage disequilibrium score regression was employed to assess heritability and genetic correlations among phenotypes, followed by genetic colocalization analysis to discern shared genetic variants. A transcriptome-wide association study (TWAS) was also performed to pinpoint gene expression profiles.

RESULTS

Genetically predicted AITD is associated with an increased risk of OLP (OR[95% CI]: 1.44[1.19,1.74], P=1.61 × 10-4), potentially mediated by hypothyroidism. There is strong evidence of colocalization between AITD and OLP, with a shared PTPN22 gene variant driving this association. TWAS further identified RNASET2 and FGFR1OP within the HLA region as high-confidence shared genes for both conditions.

CONCLUSION

Our study provides novel evidence of a possible genetic association between AITD and OLP. These findings highlight the critical role of endocrine alterations in maintaining oral immune homeostasis, though further research is warranted to validate our findings.

Development and biopharmaceutical evaluation of aqueous micelle based corticosteroid formulations for topical treatment of oral lichen planus

The dearth of approved products to treat oral lichen planus (OLP) compels off-label use of dermatological corticosteroid formulations not optimized for indications in the oral cavity. The aims of this study were to develop aqueous micelle based formulations of triamcinolone acetonide (TA) and fluocinonide (FLU), using D-tocopheryl polyethylene glycol succinate, and to investigate corticosteroid delivery to the epithelium-lamina propria junction region - the anatomical target for OLP treatment - in comparison to that from marketed products. Total mucosal deposition of TA after application of Kenacort® A Orabase® (0.1 % TA) and micellar hydrogel (0.1 %) was 242.1 ± 68.5 and 5936.7 ± 1269.6 ng/cm2, respectively. For FLU, deposition after application of Novoter (0.05 % FLU) and micellar hydrogel (0.05 %) was 617.1 ± 126.5 and 2580.0 ± 285.5 ng/cm2, respectively. A buccal biodistribution study showed that application of micelle hydrogels under occlusion for 30 min delivered 117.0 ± 15.6 ng/cm2 and 225.6 ± 36.7 ng/cm2, of TA and FLU, respectively, to the epithelium-lamina propria junction region. In contrast, the amounts deposited after applying Kenacort® A Orabase® and Novoter, were < LOQ. The results demonstrated that TPGS-based micelles improved mucosal bioavailability of TA and FLU in the epithelium-lamina propria junction region and might serve to improve topical OLP therapy.

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.

Role of SIRPG gene in type 1 diabetes and lichen planus

Type 1 diabetes (T1D) is a form of diabetes caused by pancreatic β-cell destruction and absolute insulin deficiency. Lichen planus (LP) is an idiopathic inflammatory skin disease of unclear etiology. The role of SIRPG gene dysregulation in T1D and LP remains unclear. Mendelian randomization (MR) using matched samples was employed to study causal relationship between T1D and increased risk of LP. T1D-related single nucleotide polymorphism identification was conducted. Datasets GSE156035 for T1D and GSE52130 for LP were obtained from gene expression omnibus. Differentially expressed genes were identified, analyses included weighted gene co-expression network analysis, functional enrichment, gene set enrichment analysis, and protein-protein interaction network construction and analysis. Heatmaps of gene expression levels were generated. Comparative toxicogenomics database was used to identify diseases most relevant to core genes. Inverse variance weighted, MR-Egger, weighted median methods estimated genetic predisposition between T1D and LP, showing consistent positive correlations using both weighted median and inverse variance weighted methods. Horizontal pleiotropy analysis with MR-Egger intercept indicated no evidence of significant directional pleiotropy (P = .70645) for LP. There was no evidence of directional pleiotropy effects between T1D and LP. One hundred eighteen differentially expressed genes were identified. In biological processes, they were mainly enriched in apoptosis, inflammatory response, insulin receptor signaling pathway, glucose metabolism. In cellular components, enrichment was observed in mediator complex and replication fork. In molecular function, they were concentrated in leukotriene receptor activity and helicase activity. Kyoto Encyclopedia of Genes and Genomes analysis revealed enrichment in metabolic pathways, PI3K-Akt signaling pathway, cell cycle, p53 signaling pathway, AGE-RAGE signaling pathway in diabetic complications. Weighted gene co-expression network analysis with a soft threshold power of 4. SIRPG showing high expression in both T1D and LP samples. There is a positive causal relationship between T1D and LP. Comparative toxicogenomics database analysis revealed associations of core genes with metabolic syndrome, lipid metabolism disorders, cardiovascular diseases, immune system diseases, peripheral neuropathic pain, and inflammation. SIRPG is highly expressed in both T1D and LP, providing a new insight into the pathogenesis of T1D and LP.

Alterations of oral microbiome and metabolic signatures and their interaction in oral lichen planus

Background

Oral lichen planus (OLP) is a chronic oral mucosal inflammatory disease with a risk of becoming malignant. Emerging evidence suggests that microbial imbalance plays an important role in the development of OLP. However, the association between the oral microbiota and the metabolic features in OLP is still unclear.

Methods

We conducted 16S rRNA sequencing and metabolomics profiling on 95 OLP patients and 105 healthy controls (HC).To study oral microbes and metabolic changes in OLP, we applied differential analysis, Spearman correlation analysis and four machine learning algoeithms.

Results

The alpha and beta diversity both differed between OLP and HC. After adjustment for gender and age, we found an increase in the relative abundance of Pseudomonas, Aggregatibacter, Campylobacter, and Lautropia in OLP, while 18 genera decreased in OLP. A total of 153 saliva metabolites distinguishing OLP from HC were identified. Notably, correlations were found between Oribacterium, specific lipid and amino acid metabolites, and OLP's clinical phenotype. Additionally, the combination of Pseudomonas, Rhodococcus and (±)10-HDoHE effectively distinguished OLP from HC.

Conclusions

Based on multi-omics data, this study provides comprehensive evidence of a novel interplay between oral microbiome and metabolome in OLP pathogenesis using the oral microbiota and metabolites of OLP patients.

Molecular Targets of Plant-Derived Bioactive Compounds in Oral Squamous Cell Carcinoma

BACKGROUND

With a significant increase in both incidence and mortality, oral cancer-particularly oral squamous cell carcinoma (OSCC)-is one of the main causes of death in developing countries. Even though there is evidence of advances in surgery, chemotherapy, and radiotherapy, the overall survival rate for patients with OSCC has improved, but by a small percentage. This may be due, on the one hand, to the fact that the disease is diagnosed when it is at a too-advanced stage, when metastases are already present.

METHODS

This review explores the therapeutic potential of natural herbal products and their use as adjuvant therapies in the treatment of oral cancer from online sources in databases (PubMed, Web of Science, Google Scholar, Research Gate, Scopus, Elsevier).

RESULTS

Even if classic therapies are known to be effective, they often produce many serious side effects and can create resistance. Certain natural plant compounds may offer a complementary approach by inducing apoptosis, suppressing tumor growth, and improving chemotherapy effectiveness. The integration of these compounds with conventional treatments to obtain remarkable synergistic effects represents a major point of interest to many authors. This review highlights the study of molecular mechanisms and their efficiency in in vitro and in vivo models, as well as the strategic ways in which drugs can be administered to optimize their use in real contexts.

CONCLUSIONS

This review may have a significant impact on the oncology community, creating new inspirations for the development of more effective, safer cancer therapies with less toxic potential.

Perturbed saliva microbiome is gender-specific in patients with oral lichen planus

OBJECTIVE

To understand the gender characteristics of oral lichen planus (OLP) by identifying the gender-specific salivary microbiome and its potential biomarkers.

METHODS

A gender-based study was undertaken, commencing with the collection of saliva samples, followed by 16S rRNA gene sequencing, to explore the differences in the composition of saliva microbiome in OLP patients (40 males and 56 females) and healthy controls (40 males and 56 females), respectively.

RESULTS

Both male and female OLP patients had significant differences in saliva microbiome composition from healthy controls, especially in female patients. Notably, Pseudomonas was only enriched in female patients. Rhodococcus (AUC: 0.91) and Pseudomonas (AUC: 0.97) had great potential as diagnostic biomarkers in male and female patients, respectively. The KEGG results showed metabolic dysfunction was more pronounced in female patients and a high level of microbial metabolism in diverse environments, ABC transporters, Quorum sensing and Two-component system. Capnocytophaga was negatively correlated with the erosion area in male patients. Neisseria was negatively correlated with the erosion area and Rothia was positively correlated with the pain level in female patients.

CONCLUSIONS

Our study revealed gender-specific perturbation in salivary microbiome within OLP patients, suggesting that the male and female patients with OLP may have different pathogenesis.

Genetic and therapeutic for oral lichen planus and diabetes mellitus: a comprehensive study

BACKGROUND

This study employed a bidirectional Mendelian Randomization (MR) approach to explore the causal relationships between Oral Lichen Planus (OLP), diabetes mellitus (DM), and glycemic control. It also aims to identify potential pharmacological and herbal treatments that effectively address both OLP and the metabolic dysfunctions associated with DM.

METHODS

This study employs a two-way MR approach to investigate the potential causal relationships between diabetes type and glycated hemoglobin (HbA1c) levels, and the risk of OLP. We analyzed differentially expressed genes from the OLP dataset in the Genomics Expression Omnibus (GEO) database, cross-referencing these with HbA1c-related genes for enrichment analysis. Additionally, the Drug-Gene Interaction Database (DGIdb) and Traditional Chinese Medicine Systems Pharmacology Database (TCMSP) were utilized to assess the effectiveness of specific drugs, herbs, and ingredients in treating OLP while managing blood glucose levels.

RESULTS

The MR analysis revealed a significant association between Type 1 Diabetes mellitus (T1DM) and an increased risk of OLP, unlike Type 2 Diabetes mellitus (T2DM). This finding indicates a unique immunological interaction in T1DM that may predispose individuals to OLP. The drug prediction analysis focused on core targets linked to OLP and HbA1c, evaluating the therapeutic potential of retinoic acid, prednisone, and thalidomide for treating OLP and regulating blood glucose levels. Additionally, herbal medicines such as Ecliptae herbaand Amygdalus communis vas, along with herbal ingredients like quercetin, luteolin, and 17-beta-estradiol, were identified for their anti-inflammatory properties and potential to mitigate metabolic dysfunction in diabetes.

CONCLUSION

The study highlighted a complex interplay between diabetes and OLP, underscoring the efficacy of integrated therapeutic strategies that target both conditions. The findings suggest that both pharmaceutical and herbal treatments can effectively manage the clinical manifestations of OLP and associated metabolic challenges. This holistic approach to treatment could significantly enhance patient outcomes by addressing the interconnected aspects of these chronic conditions.

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.

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.

Differences in the landscape of colonized microorganisms in different oral potentially malignant disorders and squamous cell carcinoma: a multi-group comparative study

BACKGROUND

The role of microbes in diseases, especially cancer, has garnered significant attention. However, research on the oral microbiota in oral potentially malignant disorders (OPMDs) remains limited. Our study investigates microbial communities in OPMDs.

MATERIALS AND METHODS

Oral biopsies from19 oral leukoplakia (OLK) patients, 19 proliferative verrucous leukoplakia (PVL) patients, 19 oral lichen planus (OLP) patients, and 19 oral lichenoid lesions (OLL) patients were obtained. 15 SCC specimens were also collected from PVL patients. Healthy individuals served as controls, and DNA was extracted from their paraffin-embedded tissues. 2bRAD-M sequencing generated taxonomic profiles. Alpha and beta diversity analyses, along with Linear Discriminant Analysis effect size analysis, were conducted.

RESULTS

Our results showed the microbial richness and diversity were significantly different among groups, with PVL-SCC resembling controls, while OLK exhibited the highest richness. Each disease group displayed unique microbial compositions, with distinct dominant bacterial species. Noteworthy alterations during PVL-SCC progression included a decline in Fusobacterium periodonticum and an elevation in Prevotella oris.

CONCLUSIONS

Different disease groups exhibited distinct dominant bacterial species and microbial compositions. These findings offer promise in elucidating the underlying mechanisms of this disease.

Lichen Planus: What is New in Diagnosis and Treatment?

Lichen planus (LP), an idiopathic, multifaceted chronic inflammatory disease with a heterogeneous clinical presentation, affects approximately 0.5-1% of the population. The various clinical manifestations of LP fall into three broad categories, namely cutaneous, appendageal, and mucosal, with further subclassification depending on the morphology and distribution patterns of individual lesions. There is mounting evidence that LP has systemic associations, including autoimmune conditions, glucose intolerance, dyslipidemia, and cardiovascular disorders. Cutaneous hypertrophic and mucosal forms of LP are at a heightened risk for malignant transformation. Familiarity with these potential associations in conjunction with long-term follow-up and regular screening could lead to a timely diagnosis and management of concomitant conditions. In addition, the frequent quality of life (QoL) impairment in LP underscores the need for a comprehensive approach including psychological evaluation and support. Several treatment strategies have been attempted, though most of them have not been adopted in clinical practice because of suboptimal benefit-to-risk ratios or lack of evidence. More recent studies toward pathogenesis-driven treatments have identified Janus kinase inhibitors such as tofacitinib, phosphodiesterase-4 inhibitors such as apremilast, and biologics targeting the interleukin-23/interleukin-17 pathway as novel therapeutic options, resulting in a dramatic change of the treatment landscape of LP. This contemporary review focuses on the diagnosis and management of LP, and places emphasis on more recently described targeted treatment options.

Novel Functional Dressing Materials for Intraoral Wound Care

Intraoral wounds represent a particularly challenging category of mucosal and hard tissue injuries, characterized by the unique structures, complex environment, and distinctive healing processes within the oral cavity. They have a common occurrence yet frequently inflict significant inconvenience and pain on patients, causing a serious decline in the quality of life. A variety of novel functional dressings specifically designed for the moist and dynamic oral environment have been developed and realized accelerated and improved wound healing. Thoroughly analyzing and summarizing these materials is of paramount importance in enhancing the understanding and proficiently managing intraoral wounds. In this review, the particular processes and unique characteristics of intraoral wound healing are firstly described. Up-to-date knowledge of various forms, properties, and applications of existing products are then intensively discussed, which are categorized into animal products, plant extracts, natural polymers, and synthetic products. To conclude, this review presents a comprehensive framework of currently available functional intraoral wound dressings, with an aim to provoke inspiration of future studies to design more convenient and versatile materials.

Use of the Hospital Anxiety and Depression Scale in Patients with Oral Lichen Planus: An Institutional Experience

Background Oral lichen planus (OLP) is a chronic inflammatory disorder affecting the oral mucosa. It commonly appears in reticular and erosive forms, among other variants that include bullous, papular, and plaque types. This condition can greatly diminish a patient's quality of life due to prevailing discomfort and anxiety. Materials and methodology A retrospective study was conducted involving patients with OLP in the Department of Oral Medicine and Radiology, Saveetha Dental College and Hospitals, Chennai, India, measuring their anxiety and depression levels using the Hospital Anxiety and Depression Scale (HADS). Patient data were extracted from the private institution's electronic data recording system from June 1, 2023, to June 30, 2024. The retrieved data also included parameters such as age, gender, chief complaint, associated comorbidities, habit history, type of clinical variant, and previous medication history. SPSS Version 26.0 (IBM Corp., Armonk, NY) was employed for data analysis, utilizing Fisher's exact tests, chi-square tests, and Mann-Whitney U tests for comparisons, with a p-value of <0.05 considered as significant. To compare proportions between groups, the chi-square test was applied, and when the expected cell frequency was less than 5, Fisher's exact test was used. Results Out of 1,500 outpatients in the department, 367 were diagnosed with OLP and 212 met the diagnostic criteria for inclusion in a one-year study (June 1, 2023, to June 30, 2024). The most frequently reported age group was 51-60 years, representing 27.4% (n = 58) of the total population, with a female predominance of around 62.7% (n = 133). Patients' associated comorbidities revealed the prevalence of Grinspan syndrome in around 9.4% (n = 20). Additionally, the habit history indicated no significant history in 92% (n = 198) of cases. The majority of the study population was symptomatic, reporting a chief complaint of burning sensation (46.2%) (n = 98). The most common clinical variant reported was reticular (53.8%) (n = 114), followed by the erosive variant (36.8%) (n = 78). Medication history revealed that triamcinolone acetonide 0.1% (42.9%) (n = 91) was the most commonly prescribed medicine, followed by prednisolone 5 mg (32.5%) (n = 69). The HADS score indicated that 48.58% (n = 103) of patients had abnormal anxiety scores (mean of 15.8 ± 2.02), while 42.4% (n = 90) exhibited abnormal depression scores (mean of 16.3 ± 2.07). Notably, patients with the erosive variant showed higher anxiety scores compared to those with the reticular variant, with an average score of 9.3 ± 1.07, with a p-value of 0.041. Conclusion The findings underscore the substantial psychological burden associated with OLP, which affects patient's emotional well-being and treatment adherence. Addressing these psychological concerns through regular assessments and supportive interventions is crucial for improving the standard of living.

Development and validation of the Oral Lichen Planus-Disease Activity Scale: a novel tool for comprehensive clinical assessment

OBJECTIVE

To develop and validate the Oral Lichen Planus-Disease Activity Scale (OLP-DAS) for assessing overall disease activity of OLP.

METHODS

The OLP-DAS was created by refining the Thongprasom criteria, incorporating inputs from the literature and expert review, and integrating pain assessment. Content validity was evaluated in a virtual meeting with 8 Oral Medicine specialists. Reliability and validity of the final version were examined. Seventeen OLP subjects were assessed for disease activity by 10 investigators using the OLP-DAS, Oral Disease Severity Score (ODSS), OLP-Investigator Global Assessment (OLP-IGA), and Reticular-Erythema-Ulcerative (REU) scale. Convergent validity was assessed by rating 160 OLP subjects using the OLP-DAS, ODSS, and OLP-IGA. Inter-rater and intra-rater reliability, along with convergent validity, were analyzed using intraclass correlation coefficients (ICCs) and Spearman's rank correlation coefficients (rs).

RESULTS

The final OLP-DAS achieved excellent content validity indices. Inter-rater and intra-rater ICCs for total OLP-DAS scores were 0.93 and 0.96, respectively. Total OLP-DAS scores exhibited strong positive correlations with the ODSS and OLP-IGA (rs = 0.94 and rs = 0.76; P < 0.001, respectively). The OLP Severity Index (OLP-SI), a component of the OLP-DAS, showed very strong positive correlations with OLP disease activity parameters of the ODSS (rs = 0.90; P < 0.001).

CONCLUSIONS

The OLP-DAS is a valid and reliable clinician-reported outcome measure (CROM) for evaluating OLP disease activity.

CLINICAL RELEVANCE

The OLP-DAS, as a standardized CROM for OLP, is valuable for both routine clinical assessments and research applications.

Relationship between Oral Lichen Planus and Cardiovascular Disease of Atherosclerotic Origin: Systematic Review and Meta-Analysis

Background/Objectives: Oral lichen planus (OLP) is a chronic inflammatory autoimmune disease of the oral mucosa that affects between 0.5% and 2% of the general population. In the last decade, several studies have associated cardiovascular diseases (CVDs) with some inflammatory skin diseases such as oral lichen planus, demonstrating the presence of dyslipidemia in these pathologies. The objective of this work is to review whether patients with OLP show higher dyslipidemia and CRP levels compared to a healthy control population without OLP. Methods: Searches were carried out in Medline, Scopus, and Cochrane. The studies had to perform a histopathological diagnosis for OLP and the patients could not take any medication to treat this disorder. Non-lichenoid reactions were included. Results: After an initial search that provided us with 254 papers, this number was reduced to 10 articles after a detailed evaluation. All of them were case-control studies that compared the presence of analytical cardiovascular risk factors in patients affected by OLP and in healthy subjects. Conclusions: There is no scientific evidence of the possible association between OLP and CVDs. The only association we can prove is the one between OPL and CVD risk factors, especially those related to the lipid profile. More studies are needed in order to evaluate this relationship in patients diagnosed with CVDs.

Integrative Approaches for the Diagnosis and Management of Erosive Oral Lichen Planus

Erosive oral lichen planus (EOLP) represents a significant challenge in dental and medical management due to its chronic inflammatory nature, painful symptoms, and impact on quality of life. This study aims to evaluate the current diagnostic approach with novel non-invasive techniques, such as dermoscopy, and also the landscape of treatment options for EOLP, focusing on its efficacy, safety, and the challenges that it present in clinical practice. Through a comprehensive literature review, we explored the use of topical corticosteroids, systemic immunosuppressants, biologics, and Janus kinase (JAK) inhibitors in treating EOLP, alongside examining patient compliance, psychological impacts, and the risk of adverse effects and recurrence. Our findings reveal that while topical corticosteroids are the cornerstone of EOLP treatment, offering symptomatic relief, their long-term use is limited by side effects and tolerance development. Systemic therapies and biologics provide alternatives for refractory cases but necessitate careful adverse effect monitoring. JAK inhibitors show promise as an innovative treatment avenue but require more evidence on long-term safety and efficacy. This study highlights the necessity of personalized treatment approaches due to the variable disease course and response to treatment, underscoring the importance of a multidisciplinary strategy in managing EOLP. The complexity of EOLP treatment, compounded by its psychological and quality of life impacts, demands ongoing research into targeted therapies, the establishment of standardized treatment protocols, and the development of effective outcome measures to improve patient care and treatment outcomes.

Inflammatory cytokines and oral lichen planus: a Mendelian randomization study

Background

Inflammatory cytokines have long been considered closely related to the development of oral lichen planus (OLP), and we further explored the causal relationship between the two by Mendelian randomization (MR) method.

Methods

We performed bidirectional MR analyses by large genome-wide association studies (GWAS). The data included a large-scale OLP dataset, as well as datasets of 41 inflammatory cytokines. All data were obtained from the University of Bristol database, which includes 41 inflammatory cytokines, and the GWAS Catalog database, which includes 91 inflammatory cytokines. OLP data were obtained from the Finngen database, which includes 6411 cases and 405770 healthy controls. We used the inverse variance weighted (IVW) method, MR-Egger method, weighted median method, simple mode method and weighted mode method to analyze the causal relationship between inflammatory cytokines and OLP, and we also combined with sensitivity analysis to further verify the robustness of the results. We performed a meta-analysis of positive or potentially positive results for the same genes to confirm the reliability of the final results.

Results

We primarily used the IVW analysis method, corrected using the Benjamin Hochberg (BH) method. When p<0.00038 (0.05/132), the results are significantly causal; when 0.00038

Conclusion

There is a causal association between OLP and some inflammatory cytokines, which may play an important role in the pathogenesis of OLP and require further attention.

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Key Words

• Mendelian randomization
• immunity
• inflammation
• inflammatory cytokines
• oral lichen planus

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MESH Headings

• Humans
• Cytokines/genetics
• Genome-Wide Association Study
• Lichen Planus, Oral/genetics
• Mendelian Randomization Analysis
• Reproducibility of Results

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Affiliation(s)

Xin Chen Department of Oral and Maxillofacial Surgery, Jiangyin People's Hospital Affiliated to Nantong University, Wuxi, Jiangsu, China
Simin Zhang Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi’an Jiaotong University, Xi’an, Shaanxi, China Department of General Dentistry, College of Stomatology, Xi’an Jiaotong University, Xi’an, Shaanxi, China
Xiao Wu Endodontic Department, School of Stomatology, Nanjing Medical University, Nanjing, Jiangsu, China
Yuxi Lei Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi’an Jiaotong University, Xi’an, Shaanxi, China Department of Emergency Room, College of Stomatology, Xi’an Jiaotong University, Xi’an, Shaanxi, China
Bing Lei Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi’an Jiaotong University, Xi’an, Shaanxi, China Department of General Dentistry, College of Stomatology, Xi’an Jiaotong University, Xi’an, Shaanxi, China
Zhibai Zhao Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi’an Jiaotong University, Xi’an, Shaanxi, China Department of General Dentistry, College of Stomatology, Xi’an Jiaotong University, Xi’an, Shaanxi, China

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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.

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.

Diagnostic value of 8-OHdG, 8-iso-PGF2α and TNF-α levels in blood for early carcinogenesis of erosive oral lichen planus

BACKGROUND

Oral cancer has a high worldwide incidence and mortality rate showing an upward trend year by year, predominantly occurring in emerging countries. Oral squamous cell carcinoma (OSCC) is one of the main types of oral cancer, accounting for more than 90% of all cases in oral cancer.

OBJECTIVE

To evaluate the diagnostic value of 8-hydroxy-2'-deoxyguanosine (8-OHdG), 8-iso-Prostaglandin F2alpha (8-iso-PGF2α) and tumor necrosis factor (TNF)-α as biomarkers in the early carcinogenesis of erosive oral lichen planus (EOLP) by measuring their levels in the blood of patients with EOLP and oral squamous cell carcinoma (OSCC).

METHODS

A total of 69 patients were enrolled in this case-control study [including an OSCC group (n= 23), an EOLP group (n= 23), and an age- and gender-matched healthy control group (n= 23)]. Blood levels of 8-OHdG, 8-iso-PGF2α and TNF-α were measured using enzyme-linked immunosorbent assay (ELISA). Statistical differences in these indicators among the three groups were analyzed.

RESULTS

Plasma levels of 8-OHdG and 8-iso-PGF2α in the OSCC group were significantly higher than those in both the EOLP group and the control group (all P< 0.05); no significant statistical difference was found between the EOLP group and the control group. Serum levels of TNF-α in both the OSCC and EOLP groups were elevated compared with the control group, showing significant differences among all three groups (all P< 0.05). Receiver operating characteristic (ROC) curves revealed that plasma 8-OHdG and 8-iso-PGF2α levels and serum TNF-α levels had diagnostic effects on early carcinogenesis in EOLP patients. When these indicators were combined for diagnosis, the diagnostic effect was enhanced, with an area under the ROC curve (AUC) values of 0.819.

CONCLUSION

8-OHdG, 8-iso-PGF2α and TNF-α may serve as biological indicators for monitoring the early carcinogenesis of EOLP, and the diagnostic effect was augmented when these indicators were combined.

Lichenoid mucocutaneous reactions associated with sintilimab therapy in a non-small cell lung adenocarcinoma patient: case report and review

The immune checkpoint inhibitor (ICI), anti-programmed cell death receptor-1 (PD-1) antibody, has gained widespread approval for treating various malignancies. Among the immune-related adverse reactions (irAEs) during ICI treatment, the lichenoid reaction is noteworthy. Sintilimab, a new PD-1 inhibitor, has secured approval in China for treating refractory non-Hodgkin's lymphoma, and phase I/II clinical trials for other solid tumors are ongoing both domestically and abroad. This paper presents a case of a mucocutaneous lichenoid reaction associated with sintilimab therapy, its diagnosis, and management. Our study, using multiplex immunofluorescence staining, reveals localized infiltration of CD4+ and CD8+ T lymphocytes in the subepithelial lamina propria region with upregulated PD-1 expression, implying an association between PD-1 expression upregulation and lichenoid reactions provoked by PD-1 monoclonal antibody. We provide a summary of clinical characteristics and treatment guidelines for lichenoid reactions induced by ICIs from previous reports, highlighting the success of a combined therapeutic regimen of oral antihistamines and topical corticosteroids in controlling symptoms without interrupting ICI treatment.