Candidal infection in oral lichen planus

Association of oral candidiasis with oral lichen planus in patients using corticosteroid therapy - Meta-analysis

Oral lichen planus (OLP) is a chronic inflammatory disease that commonly affects the skin and mucous membranes. There is a difference of opinion among clinicians about whether OLP has been associated with oral candidiasis. Nonetheless, in OLP patients, the oral candidiasis prevalence rate ranges from 7.7 to 16.6%, as established through biopsy findings, whereas 37-50% of the prevalence rate has been noticed in culture findings. Oral candidiasis has been linked to several local and systemic factors, including salivary gland dysfunction, dental prostheses, topical or inhaled corticosteroids, smoking, and the use of systemic medications. The aim was to highlight the association of Candida in patients diagnosed with OLP, correlate the use of steroid therapy, and enumerate the factors of using steroid therapy as implicated causes for oral candidiasis. A search was made using search engines such as PubMed, Scopus, Cochrane Database of Systematic Reviews, Science Citation Index, NIH Public Access, and Clarivate Analytics (Figure 1). The keywords using the research option for this field were "Oral Candidiasis" AND "Oral Lichen planus" or "Candidiasis" AND "Corticosteroids" or "Topical Corticosteroids" AND Oral Lichen planus or "Inhalation Corticosteroids" AND "Candidiasis" or "Oral Lichen planus" AND "Corticosteroids." The database search was made for the duration of 1991 to -2021 (Table 1). Additional articles were obtained regarding the literature on OLP and oral candidiasis and were considered background material. The incidence of oral candidiasis and associated lichen planus following steroid therapy enlisted by various authors has been addressed. According to the results of this study, there is a positive correlation between the presence of oral candidiasis in the OLP's patients treated with corticosteroids. Finally, this meta-analysis concluded that there is a positive correlation between the presence of Candida species in OLP and steroid medication.

Proteomic and microbiota analyses of the oral cavity during psychological stress

Psychological stress is associated with various oral diseases such as aphthous stomatitis, oral lichen planus, taste disturbances and glossodynia. However, the underlying mechanism is still unknown. The aim of this study was to determine the effect of psychological stress on salivary proteins and the oral microbiota in a rat model of chronic restraint stress. Six-week-old Sprague Dawley rats were subjected to restraint stress for four hours daily for 1 month. The behavior, weights of the adrenal glands, and serum corticosterone levels were evaluated as stress markers. Proteomic analysis of the saliva was performed using two-dimensional gel electrophoresis followed by mass spectrometry and Western blotting. Analysis of the oral microbiota was performed via 16S rRNA next-generation sequencing. The low mean body weights, lower number of entries and time spent in the open arm of elevated plus maze, high adrenal gland/body weight ratios, and high serum corticosterone levels confirmed the high levels of stress in the stress group of rats compared to the controls. Thirty-three protein spots were found to be significantly altered between the two groups. After silver staining, seven visible spots were subjected for mass spectrometry, and the expression levels of the two most significantly altered proteins, BPI fold containing family A member 2 and von Ebner’s gland protein, were confirmed by Western blotting. 16S rRNA sequencing analysis revealed a significant reduction in alpha diversity in the stress group compared to the controls. The abundances of oral bacteria, such as Facklamia and Corynebacterium, were significantly altered between the two groups. Additionally, analysis with PICRUSt2 software predicted 37 different functional pathways to be altered between the groups. In conclusion, the present study identified altered salivary proteins and oral microbiota due to psychological stress. These findings might aid in understanding the pathogenesis of stress-related oral diseases.

Hypha essential genes in Candida albicans pathogenesis of oral lichen planus: an in-vitro study

BACKGROUND

Hypha essential genes (HEGs) of Candida Albicans have been emerging into scholar's attention, little known about their functions in oral lichen planus (OLP) with an uncovered etiology. This research aimed to observe necessary genes in biphasic C. albicans from OLP and study their relevance in pathogenesis, so as to evaluate possible roles of morphologic switching in etiology of OLP.

METHODS

Samples were collected from OLP lesions of patients, mycelia were cultured and total RNA was extracted then subjected to reverse transcription-PCR and real-time PCR.

RESULTS

HWP1 and HGC1 were significantly expressed in hyphae phase and weakly detected in yeast phase, while there was no significant difference of EFG1, ALS3, and ECE1 between in yeast and mycelia.

CONCLUSION

HGC1 and HWP1 were confirmed to be hypha essential genes, with HGC1 for hypha morphogenesis and HWP1 for adhesion invasion in pathogenesis of C. albicans in OLP. ALS3, ECE1 and EFG1 played minor roles in hyphae maintenance and adhesion for hyphae. These might be deemed as hints for the etiology of OLP and indicate HGC1 and HWP1 to be a priority of potential drug target.

Prevalence of fungal hyphae in potentially malignant lesions and conditions-does its occurrence play a role in epithelial dysplasia?

BACKGROUND

Oral cancer is a major public health problem in India. A key factor that has led to lack of improvement in prognosis of oral cancer over the years, is delay in diagnosis and treatment. In many instances, a significant proportion of oral squamous cell carcinomas develop from premalignant lesions and conditions. Identification of such lesions and conditions is very important in order to prevent malignant transformation. The role of fungal infections has been studied and holds promise as an indicator to predict malignant transformation. So we designed a study to analyze the prevalence of fungal hyphae in biopsies of patients with clinically diagnosed cases of premalignant lesions and conditions.

AIMS AND OBJECTIVES

To determine and compare the prevalence of fungal hyphae in biopsies of patients with clinically diagnosed cases of potentially malignant lesions and conditions and to assess the possible association between the degree of epithelial dysplasia and presence or absence of fungal hyphae.

MATERIALS AND METHODS

Clinically suspected and histopathologically diagnosed 70 cases of potentially malignant lesions and conditions (29 leukoplakia, 16 submucous fibrosis and 25 lichen planus) made up the study group. Three tissue sections (5μm) of each were stained with hematoxylin and eosin (H and E), periodic acid-Schiff's reagent (PAS) and Grocott's methenamine silver (GMS) and evaluated for fungal hyphae. The data collected was statistically analyzed by using Chi-square test and Statistical Package for Social Sciences (SPSS) software.

RESULTS

The estimated prevalence of fungal hyphae in cases with or without dysplasia in leukoplakia was 41.4%, lichen planus 36% and submucous fibrosis 25%. There was a significant association between degree of epithelial dysplasia with presence or absence of fungal hyphae in all the study groups.

CONCLUSION

Presence of fungal hyphae in potentially malignant lesions and conditions may prove to be a useful indicator in predicting malignant transformation.

Mycological and histological associations of Candida in oral mucosal lesions

The present study aimed to assess the presence and level of colonization of Candida in patients with oral mucosal lesions, to determine the presence or absence of candidal hyphae in biopsy specimens and to correlate the degree of epithelial dysplasia with the number of colony-forming units of Candida. We performed a prospective study including 50 patients diagnosed as having oral potentially malignant and malignant disorders. These patients had lesions such as leukoplakia, lichen planus, lichenoid reaction, verrucous carcinoma and oral squamous cell carcinoma. An oral swish with 10 mL of normal saline was performed, and this was collected in a sterile plastic container. Candidal colony-forming units were assessed in the specimen. This was followed by a biopsy of the lesion, which was sent for histopathologic examination for dysplasia and severity, and to assess the presence or absence of candidal hyphae. The results of the present study revealed a correlation between higher Candida colonization and increasing severity of dysplasia. An effort was made to correlate Candida by histologic and mycologic means with epithelial dysplasia. If such a correlation is strongly established, then the importance of antimycotic therapy can be emphasized to avoid deterioration.

Frequency of genital involvement in women with oral lichen planus in southern iran

Background. Lichen Planus is a chronic mucocutaneous disease of immunological basis and unknown etiology. women with oral lichen planus may have concomitant manifestations in vulvovaginal areas. Objective. To determine the frequency and risk factors of genital involvement in a group of Iranian women affected by oral lichen planus. Methods. Thirty-six women with clinical and histopathological diagnosis of oral lichen planus were evaluated for demographic, historical, and clinical parameters of the oral disease. All the patients were referred for careful vulvovaginal examination, as well as histopathological assessment upon clinical indication. Results. Nineteen patients complained from genital symptoms but the number of women with the final diagnosis of genital lichen planus (n = 2) was too small to show any correlation with the parameters evaluated. Conclusion. In spite of low genital involvement possibly due to inadequate patient population, lack of follow-up visits, and contribution of genetic or ethnic factors, for conservative patient care, women with the oral lichen planus in particular those having some relevant genital symptoms, should preferably be referred for careful vulvovaginal examination. Multicenter cohort studies on women of different geographical regions or ethnicities who have genital lichen planus alone or in combination with other common sites are encouraged.

Prevalence of Candida species in erosive oral lichen planus

Background and aims

The clinical management of oral lichen planus poses considerable difficulties to the clinician. In recent years, researchers have focused on the presence of pathogenic microorganisms such as Candida albicans in the patients with refractory lichen planus. The aim of the present study was to investigate the prevalence of candida species in the erosive oral lichen planus lesions.

Materials and methods

Twenty-one patients with erosive oral lichen planus and twenty-one healthy individuals aged 18-60 were randomly selected; samples were taken from the tongue, saliva and buccal mucosa with swab friction. Theses samples were sent to the laboratory for determining the presence of candida species in cultures and direct examination method.

Results

No significant difference was found between healthy individuals and patients with erosive lichen planus regard-ing presence of candida species. The type of candida in the evaluated samples was Candida albicans in both healthy and patient groups.

Conclusion

According to the results, candida was not confirmed as an etiologic factor for erosive lichen planus lesions.

Candida in oral lichen planus patients undergoing topical steroid therapy

OBJECTIVES

To determine the incidence, intensity, and species of Candida in the oral cavity of oral lichen planus (OLP) patients who were being treated with a topical steroid.

STUDY DESIGN

The incidence and intensity of oral Candida carriage were assessed by salivary and imprint cultures. Cytological smears were used to investigate the presence of Candida spores and hyphae in the OLP lesions. Candida species were identified by a chlamydospore formation test and the API 20C system.

RESULTS

The salivary cultures were positive in 76.7% of the OLP patients and 43.3% of the controls (P = .008), whereas the imprint cultures were positive in 76.7% of the OLP patients and 40% of the controls (P = .004). A high-level Candida count in saliva was more frequently found in the OLP patients than in the controls (73.9% vs. 38.5%; P = .004). The mean scores of Candida growth from imprint cultures were higher in OLP patients than in the controls (P = .002). The mean scores of Candida growth were also higher in OLP patients who were taking xerogenic or immunosuppressive drugs (P = .038) and in OLP denture wearers (P = .022). Spores and hyphae were detected in 83.3% of the OLP lesions. Candida albicans, the most frequently isolated yeast, was found in 76.7% OLP patients and 40% of the controls.

CONCLUSIONS

The results of this study indicate that topical steroids induce Candida growth and the associated risk factors are age, medication use, and the wearing of dentures.

Current controversies in oral lichen planus: report of an international consensus meeting. Part 2. Clinical management and malignant transformation

Despite recent advances in understanding the immunopathogenesis of oral lichen planus (LP), the initial triggers of lesion formation and the essential pathogenic pathways are unknown. It is therefore not surprising that the clinical management of oral LP poses considerable difficulties to the dermatologist and the oral physician. A consensus meeting was held in France in March 2003 to discuss the most controversial aspects of oral LP. Part 1 of the meeting report focused on (1) the relationship between oral LP and viral infection, with special emphasis on hepatitis C virus (HCV), and (2) oral LP pathogenesis, in particular the immune mechanisms resulting in lymphocyte infiltration and keratinocyte apoptosis. Part 2 focuses on patient management and therapeutic approaches and includes discussion on malignant transformation of oral LP.

Presence of Candida albicans in potentially malignant oral mucosal lesions

Recently, an interest in the study of oral candidiasis has markedly increased mainly because of its association with viral infections due to human immunodeficiency, but also because of its relation with potentially malignant lesions of oral mucosa. These lesions belong to the wide group of leukoplakia. Leukoplakia is a clinical term used to describe a range of nonspecific white lesions, whose appearance does not generally correlate well with histopathologic changes; therefore, biopsy should be performed in all cases to determine which are precancerous or potentially malignant ones. In order to study the association of Candida albicans and the types of mucosal lesions, we took 30 consecutive biopsies of oral mucosa and the smears for microbiologic examination from the changed surface of mucosa and from the rest of oral cavity. The study group consisted of 30 patients, 21 women and 9 men, with the average age of 50.23 years (range, 25-77 years). In 6 cases Candida was diagnosed in mucosal biopsy. In the smear from the lesion, it was present in 3 cases, and 2 cases were found in the smear from an unchanged oral mucosa. In 9/30 cases (30%) Candida was positive regardless of the smear area or mode of diagnosis. The most common lesion is leukoplakia, diagnosed in 12/30 cases (40%), in 6 female and 6 male patients. The average age of those patients was 52.42 years. The lesions were located as follows: cheek mucosa - 5 cases; gingival mucosa - 2; lower lip - 2; floor of the mouth - 2; soft palate - 1; Candida was present in 3/12 cases. The lesion with the second highest incidence is lichen planus (9 cases), with positive Candida infection in 4/9 (44.44%). Epithelial dysplasia, although diagnosed in a very small number of cases (1/30 or 3.3%) with leukoplakia, was associated with a Candida infection. Generally, Candida is present in potentially malignant oral mucosal lesions (in 3/12 or 25% of leukoplakia cases, in 4/9 or 44.44% of lichen planus cases, and 1/1 squamous papilloma), with an increasing incidence in lesions with serious dysplastic epithelial changes.

Clinical evaluation in treatment of oral lichen planus with topical fluocinolone acetonide: a 2-year follow-up

BACKGROUND

Oral lichen planus (OLP) is a chronic inflammatory disease which is recalcitrant to medical treatment. The purpose of this study was to compare the effectiveness of various forms of the topical steroid fluocinolone acetonide applications in patients with OLP.

METHODS

Data of OLP patients were collected retrospectively from the chart record and the 97 OLP patients were divided into three groups. The first group (n = 28) was treated with a 0.1% solution of fluocinolone acetonide (FAS), the second group (n = 22) with 0.1% fluocinolone acetonide in orabase (FAO), and the third group (n = 47) with both FAS and FAO (FAS/FAO) throughout the study. Each group was clinically evaluated as complete remission (CR), partial remission (PR), or no response (NR), following the treatment. Also, the side-effect of oral candidiasis was recorded in each group.

RESULTS

Two years of treatment resulted in complete remission of 77.3, 21.4, and 17.0% of patients in the FAO, FAS, and FAS/FAO groups, respectively. There was a statistically significant difference in disease remission (P < 0.05), but not in oral candidiasis appearance (P > 0.05) among various forms of topical steroid application.

CONCLUSION

The study concluded that FAO or FAS can produce improved results in the management of OLP by long-term follow-up.

Clinical and pathological characteristics of oral lichen planus in hepatitis C-positive and -negative patients

The reported prevalence rate of anti-hepatitis C virus (HCV) antibodies in patients with oral lichen planus shows wide geographical variation and ranges from 0 to 65%. Certain characteristic clinical features have been attributed to oral lichen planus associated to HCV infection. The purpose of this investigation has been to assess hypothetical clinical differences, as well as differences in the intensity of the subepithelial inflammatory infiltrate between oral lichen planus-HCV +ve patients and oral lichen planus-HCV -ve patients. A total of sixty-two patients entered the study. Their mean age was 63.5 +/- 14.49 years, and 48.4% of them were men and 51.6% women. Patients were classified according to their serum HCV positivity. Age, sex, clinical presentation (reticular or atrophic-erosive), extension of the lesions, location of the lesions, number of locations affected, intensity of the inflammatory infiltrate and Candida albicans colonization were recorded for each patient. Reticular lichen planus was the most frequent clinical presentation in both HCV +ve (57.1%) and HCV -ve patients (63.6%). C. albicans colonization ranged from 42.8% in HCV +ve and 41.7% in HCV -ve patients. HCV + ve patients showed certain oral locations more frequently affected than HCV -ve ones: lip mucosa, 28.6% versus 7.3%; tongue, 57.1% versus 29.1%; and gingiva, 71.4% versus 23.6%. The number of affected intraoral locations was higher in HCV +ve patients (71.4%) than among HCV -ve ones (20.4%; chi2 = 8.34; P < 0.011). No statistically significant differences could be established in terms of density of subepithelial inflammatory infiltrate between the groups. Our results reinforce the need for liver examination in all patients with oral lichen planus, particularly those showing lesions on the gingiva with multiple intraoral locations affected, as no pathological differences could be identified between HCV + ve and HCV -ve patients.

Reliability of toluidine blue application in the detection of oral epithelial dysplasia and in situ and invasive squamous cell carcinomas

OBJECTIVE

The objective of this study was to evaluate the reliability of in vivo staining with toluidine blue in the detection of oral epithelial dysplasia, in situ carcinoma, and invasive squamous cell carcinomas in potentially malignant epithelial lesions (PMELs) and superficial oral ulcerations suggesting malignancy.

STUDY DESIGN

Fifty patients with PMELs and superficial oral ulcerations suggestive of malignancy were selected from those treated at the Oral Medicine Service, Faculty of Dentistry, Araraquara, Brazil. All lesions were submitted to staining with an aqueous solution of 1% toluidine blue, followed by biopsy and histologic analysis. The sensitivity, specificity, and positive and negative predictive values were calculated.

RESULTS

Histologic diagnosis revealed that 14% of the lesions analyzed were in situ carcinoma and invasive squamous cell carcinomas, 12% were epithelial dysplasias, 13% were keratosis, 40% were lichen planus, and 8% were other benign lesions. The sensitivity of the staining was 77%, the specificity 67%, and the positive and negative predictive values 43.5% and 88.9%, respectively.

CONCLUSIONS

Staining with toluidine blue was demonstrated to be highly reliable in the detection of in situ carcinoma and invasive squamous cell carcinoma, because false-negative results for the lesions did not occur. Toluidine blue staining is an adjunct to clinical judgment and not a substitute for either judgment or biopsy.

Management of oral lichen planus

Lichen planus is a relatively common disorder of the stratified squamous epithelia. Most dental and medical practitioners see patients with lichen planus, but not all are recognized as having the disease. Patients with lichen planus may have concomitant involvement of the disease in multiple sites. Oral lichen planus lesions usually have a distinctive clinical morphology and characteristic distribution, but oral lichen planus may also present a confusing array of patterns and forms, and other disorders may clinically mimic oral lichen planus. The etiopathogenesis of lichen planus appears to be complex, with interactions between genetic, environmental, and lifestyle factors. Much has now been clarified about the etiopathogenic mechanisms involved and interesting new associations, such as with liver disease, have emerged. The management of lichen planus is still not totally satisfactory in all cases and there is as yet no definitive treatment that results in long term remission, but there have been advances in the control of the condition. Amongst the many treatments available, high potency topical corticosteroids remain the most reliably effective, though topical cyclosporine, topical tacrolimus, or systemic corticosteroids may be indicated in patients whose condition is unresponsive to topical corticosteroids.

Topical corticosteroids in association with miconazole and chlorhexidine in the long-term management of atrophic-erosive oral lichen planus: a placebo-controlled and comparative study between clobetasol and fluocinonide

OBJECTIVE

To evaluate the efficacy of a combination of topical corticosteroids with topical antimycotic drugs in the therapy of atrophic-erosive forms of oral lichen planus (OLP).

PATIENTS AND METHODS

The study population consisted of 60 patients with OLP subdivided into three groups matched for sex and age. The first group (25 patients) and the second group (24 patients) received respectively 0.05% clobetasol propionate ointment or 0.05% fluocinonide ointment in an adhesive medium (4% hydroxyethyl cellulose gel) plus in each case antimycotic treatment consisting of miconazole gel and 0.12% chlorhexidine mouthwashes. The third group (11 patients), placebo group, received only hydroxyethyl cellulose gel and antimycotic treatment as above. All the treatment regimens were carried out for 6 months. Each patient was examined every 2 months during the 6-month period of active treatment and for a further 6 months of follow-up. Objective and subjective clinical progress was scored and compared between the three groups. Plasma cortisol levels were monitored in half the patients using the topical corticosteroids.

RESULTS

All patients treated with clobetasol and 90% of the patients treated with fluocinonide witnessed some improvement, whereas in the placebo group only 20% of patients improved (P < 0.0001 and P = 0.00029, respectively. However, when considering complete responses, only clobetasol gave significantly better results than placebo. Clobetasol resolved 75% of the lesions whereas fluocinonide was effective in 25% of cases and placebo in none. Clobetasol achieved better results statistically than did fluocinonide (P = 0.00442) and placebo (P = 0.00049) whereas there was no statistical difference among fluocinonide and placebo (P = 0.140). Similar results were obtained for symptoms. Both drugs were shown to be effective in the treatment of erosive lesions, but clobetasol was considerably more efficacious than fluocinonide in the atrophic areas (75% vs 25% of total response, respectively) (P = 0.00442). None of the treated patients contracted oropharyngeal candidiasis. After 6 months of follow-up, 65% of the clobetasol-treated group and 55% of the fluocinonide group were stable. Estimation of plasma cortisol levels showed no significant systemic adverse effects of clobetasol or fluocinonide.

CONCLUSIONS

Our results suggest that a very potent topical corticosteroid such as clobetasol may control OLP in most cases, with no significant adrenal suppression or adverse effects. Moreover, a concomitant antimycotic treatment with miconazole gel and chlorhexidine mouthwashes is a useful and safe prophylaxis against oropharyngeal candidiasis.

Update on oral lichen planus: etiopathogenesis and management

Lichen planus (LP) is a relatively common disorder of the stratified squamous epithelia, which is, in many ways, an enigma. This paper is the consensus outcome of a workshop held in Switzerland in 1995, involving a selection of clinicians and scientists with an interest in the condition and its management. The oral (OLP) eruptions usually have a distinct clinical morphology and characteristic distribution, but OLP may also present a confusing array of patterns and forms, and other disorders may clinically simulate OLP. Lesions may affect other mucosae and/or skin. Lichen planus is probably of multifactorial origin, sometimes induced by drugs or dental materials, often idiopathic, and with an immunopathogenesis involving T-cells in particular. The etiopathogenesis appears to be complex, with interactions between and among genetic, environmental, and lifestyle factors, but much has now been clarified about the mechanisms involved, and interesting new associations, such as with liver disease, have emerged. The management of lichen planus is still not totally satisfactory, and there is as yet no definitive treatment, but there have been advances in the control of the condition. There is no curative treatment available; immunomodulation, however, can control the condition. Based on the observed increased risk of malignant development, OLP patients should be offered regular follow-up examination from two to four times annually and asked to report any changes in their lesions and/or symptoms. Follow-up may be particularly important in patients with atrophic/ulcerative/erosive affections of the tongue, the gingiva, or the buccal mucosa. Much more research is required into the genetic and environmental aspects of lichen planus, into the premalignant potential, and into the possible associations with chronic liver, and other disorders. More clinical studies are required into the possible efficacy of immunomodulatory drugs such as pentoxifylline and thalidomide.

The frequency of fungal infection in biopsies of oral mucosal lesions

OBJECTIVE

To determine the frequency of fungal infection in biopsies of oral mucosal lesions.

MATERIALS AND METHODS

Histopathology reports issued between 1991-1995 inclusive were reviewed. During this period, a single section of each mucosal biopsy had been stained using the periodic acid-Schiff (PAS) technique.

RESULTS

A total of 223 (4.7%) biopsies contained PAS-positive fungi: 191 individuals were affected, 124 (64.9%) of whom were male. There was a significant (P < 0.01) positive association of fungal infection with moderate and severe epithelial dysplasia, median rhomboid glossitis and squamous papillomas. Where a subsequent biopsy was available, 21.9% dysplasias which were infected with fungi worsened in histological severity, as compared with 7.6% of dysplasias which were not infected at any stage. There was a significant negative association of fungal infection with benign fibrous overgrowths (P < 0.01), benign hyperkeratoses, lichenoid reactions and pyogenic granulomas (P < 0.05). The difference in frequency of infection between the tongue and other sites was also significantly higher (P < 0.01).

CONCLUSIONS

There is a statistically significant association between histologically-determined fungal infection and epithelial dysplasia, and we recommend that a PAS stain be performed whenever oral epithelial dysplasia is diagnosed, especially in male patients. On histological confirmation of dysplasia, anti-fungal therapy should be considered in the management of these lesions.

Potentially malignant epithelial oral lesions: discrepancies between clinical and histological diagnosis

OBJECTIVE

To evaluate the discrepancy index between the clinical and histological diagnosis and the prevalence of epithelial dysplasia and carcinoma in 45 patients with potentially malignant epithelial oral lesions (PMEL).

PATIENTS AND METHODS

We submitted 45 patients with PMEL to clinical examination and obtained a biopsy from each. The results of histological diagnosis were compared to the clinical diagnosis.

RESULTS

Clinical diagnosis showed that the most common PMEL was leukoplakia followed by lichen planus and by actinic cheilitis associated with leukoplakia. The most common site was the buccal mucosa. Histological diagnosis revealed that 46.7% of the PMEL were lichen planus. The discrepancy index between clinical and histological diagnosis was 24.4%. The higher discrepancy index occurred among leukoplakias. The prevalence of epithelial dysplasia and carcinoma was 17.8%.

CONCLUSIONS

We conclude that all PMEL should be submitted to a microscopic analysis because the discrepancy between clinical and histological diagnosis was present in a quarter of these lesions. Otherwise, the epithelial dysplasia and carcinoma were more frequent in the leukoplakias.

Clinical characteristics and treatment of patients with oral lichen planus in Israel

Oral lichen planus (OLP) has a multiple-site involvement, with the buccal mucosa being the most prevalent. A possible relationship between OLP and the risk of malignancies in the involved site is documented. The characteristics of OLP have been studied in different populations; however, no similar studies have been conducted in any Jewish population. The purpose of this study was to evaluate the natural history of OLP in Israeli Jewish patients. Data were collected from 157 charts of patients with histologically confirmed OLP. No evidence suggesting a connection between OLP and diabetes, cardiovascular disease, smoking, alcohol use, or positive Candida culture was found. Skin involvement of lichen planus was found in one fifth of the patients. Symptomatic OLP was noted in half of the patients, mainly in those with the erosive form. In 65% of the patients with symptoms, improvement by more than 50% was shown within 2 weeks of steroid use. The transformation rate of 1.3% of OLP into malignancy was observed in the entire group. A constant follow-up for contributing symptoms and for early diagnosis of suspected transformed lesions is of utmost importance.

Clinical management of oral and perioral candidosis

Oral candidosis is a diagnosable and treatable mucosal disease that may be complicated by various other local or systemic disease conditions. Dependable diagnosis always should include a combination of clinical signs and symptoms suggestive of candidal disease as well as positive cytologic or direct culture results. The management of candidal infections should be individualized for each patient, with concern for interactions with current medications, immune status, other concurrent mucosal diseases, and exogenous infectious sources. In selecting the appropriate therapeutic agent(s) the clinician should consider patient health factors, location and severity of infection, and the probability of chronicity.

Oral lichen planus lesions in contact with amalgam fillings: a clinical, histologic, and immunohistochemical study

Fifty-one consecutive patients had clinically diagnosed oral lichen planus (OLP) lesions in total or partial contact with amalgam fillings. The clinical features of the OLP lesions were characterized and registered, and biopsies were obtained from each OLP lesion. Histologic and immunohistochemical studies were performed, as well as tests for allergy to dental materials. The clinical diagnosis of OLP corresponded to the World Health Organization (WHO) morphologic OLP criteria in 31 (61%) cases. The remaining lesions were histologically diagnosed as mild OLP in 11 (22%) or as benign oral keratosis in nine (17%) cases. The immunohistochemical examination showed a positive reaction to fibrinogen in the basement membrane zone (BMZ) in 10 (20%) patients and to complement C3 in one (2%) patient. No positive reactions in the BMZ were found for IgA, IgG, and IgM. In 17 (33%) patients, an allergic reaction to mercury was found, and candidiasis was diagnosed in 13 (25%) patients. The true nature of OLP-like lesions in contact with amalgam fillings still remains to be explained. For that matter, we do not know whether OLP is one disease or a number of similar immunologic or other responses to various interacting stimuli. One such stimulus might be mercury from corroding amalgam fillings.

A retrospective evaluation of 193 patients with oral lichen planus

One hundred and ninety-three patients with oral lichen planus were evaluated retrospectively. Women outnumbered men by more than two to one. The mean age at lesion discovery was in the sixth decade. The buccal mucosa was the most common site of occurrence. There were concomitant systemic diseases in many of the patients. The ulcerative form was the most prevalent referred form. Therapies included observation and treatment with topical and systemic corticosteroids with and without anti-fungals and immunosuppressants. Areas of discussion include lesion location, chronicity, therapeutic modalities, malignant transformation, age, gender, symptomatology and systemic disease.

The therapy of oral lichen planus

Oral lichen planus is a chronic mucocutaneous disease that is relatively common. Although many patients are asymptomatic and require no therapy, those who exhibit atrophic and erosive lesions are often a challenge to treat. All therapies are palliative, and none is effective universally. Currently employed treatment modalities include corticosteroids administered topically, intralesionally, or systemically. Alternative therapies include topical and systemic retinoids, griseofulvin, Cyclosporine, and surgery. Other medical treatments and experimental modalities, including mouth PUVA, have been reported to be effective. Controversy concerning the efficacy of all these treatments suggests that oral lichen planus is a heterogeneous disorder. Eliminating lichenoid drug eruptions, candidiasis, trauma, contact mucositis, and emotional stress may play a role in the management of these patients. This article is a review of the many treatments and measures that have been employed in the management of patients with oral lichen planus.

Occurrence of oral leukoplakia and lichen planus in diabetes mellitus

The occurrence of oral leukoplakia and lichen planus in 1600 patients with diabetes mellitus (815 type 1: insulin-dependent, 761 type 2: non-insulin-dependent)-under care at the International Medicine Department-was studied. Precancerous lesions and conditions were diagnosed and grouped according to internationally accepted criteria. The prevalence of oral leukoplakia in diabetic patients was 6.2%, as compared to 2.2% in the healthy controls, that of oral lichen was 1.0% in the test-, and 0.0% in the control group. Leukoplakia and lichen both showed the highest occurrence in the second year of established diabetes, and their prevalence was higher among insulin-treated diabetics. Smokers were more often affected, by both kind of lesions, oral lichen showed a more frequent association with candidiasis. The prevalence of oral leukoplakia and lichen in diabetes mellitus patients was higher, than average ratios in population samples from the same country.

Oral candidosis. Clinical, historical, and therapeutic features of 100 cases

Oral candidosis is an increasingly important disease that affects a significant percentage of the population. Traditionally known as an opportunistic pathogen, the broader clinical scope of oropharyngeal candidal infections is now being recognized. The clinical and historical features of 100 patients referred for diagnosis and management of candidosis have been reviewed. The age, gender, chief complaint, medical history, medications, and clinical findings have been noted. A wide range of clinical signs and symptoms, and the rationale behind the topical and systemic antifungal therapies provided to this patient population, are discussed.

Chronic ulcerative stomatitis associated with stratified epithelial specific antinuclear antibodies. A case report of a newly described disease entity

A case of erosive oral lesions associated with an unusual direct and indirect immunofluorescent pattern is presented. Rather than a submucosal band or intramucosal intercellular deposition, the pattern is that of an antinuclear antibody that reacts only with stratified epithelium. The clinical similarity of this case to erosive lichen planus is discussed. The usefulness of direct and indirect immunofluorescence techniques in the diagnosis of erosive oral lesions is stressed.

Resolution of oral lichenoid lesions after replacement of amalgam restorations in patients allergic to mercury compounds

The significance of contact allergy in patients with various oral symptoms was studied. Positive patch-test reactions to mercury compounds were found in 21/91 patients. Of these, 18 had lichenoid lesions in oral mucosa in close contact to amalgam fillings, and three patients with contact allergy had neither amalgam fillings in their teeth nor visible oral lesions. Amalgam replacement was carried out in 15/18 symptomatic patients. The fillings were replaced with gold in three cases, composite resin fillings in six, glass ionomer in three and both gold and composite materials in three cases. In 10 patients there was complete replacement and in five it was restricted to the fillings adjacent to the mucosal lesions. After a mean follow-up period of 3.2 years a complete cure was seen in seven patients, each of whom had had all their fillings changed. A marked improvement occurred in six patients, and there was no change in two.

A prospective study of findings and management in 214 patients with oral lichen planus

The findings in this prospective study of 214 patients with oral lichen planus were similar to those found in our 1985 evaluation of 570 patients with oral lichen planus. These two groups of patients with oral lichen planus patients constitute the largest series from one clinic. Oral lichen planus was found mainly in women and most commonly on the buccal mucosa. Spontaneous remissions were infrequent (6.5%), as were malignant transformations (2.3%) in a mean follow-up of 7.5 years. The erosive form of oral lichen planus was most common and was almost always associated with pain. Reproducibly successful management of this T-lymphocyte disease was obtained by selective use of systemic and/or topical corticosteroids. Oral lichen planus was not associated with any evident systemic disease, drug, smoking, or genetic predisposition. Although statistically Candida albicans does not appear to occur disproportionately in large samples of patients with oral lichen planus, in some of the Candida-positive patients, antifungal medications appeared to be useful.