A clinical study of 205 patients with oral lichen planus

A New Scoring System of Oral Lichen Planus

Lichen planus (LP) is a chronic, immune-mediated mucocutaneous disorder increasingly becoming common in the general population with female predominance. Clinically, there are different forms of lichen planus with the presence of the main characteristic feature of Wickham striae. Literature, to date, is abundant with various scoring systems of oral lichen planus, and among them, the most commonly followed scoring system was the one proposed by the Thongprasom system because of its simplicity and ease of application.

Aim

The aim of the present study is to critically review all the disease scoring systems on oral lichen planus (OLP) that have been reported in the literature during the past decades. A systematic literature search was performed using PUBMED, MEDLINE, EMBASE, and COCHRANE Library with language restriction to English. The search was carried out incorporating the published literature from 1980 to 2020 using the MeSH (medical subject heading) terms. A literature search was done using keywords: Staging, Grading, Oral lichen planus, Diagnostic, and Therapeutic. Out of 25 publications, related to search strategy, 22 full articles, which were related to the disease scoring system for oral lichen planus, were acquired for further inspection. Out of the 22 articles, 15 articles met the inclusion criteria. The data was collected and a brief summary of the studies regarding the different disease scoring systems for oral lichen planus was explained. Taking into consideration, the parameters were not included in the previous disease scoring system. A new proposal encompassing a scoring system for oral lichen planus considering the missing parameters along with an amalgamation of histopathological criteria of dysplasia is presented. It also proposes to grade and stage the lesions and recommend appropriate therapy for each of such lesions.

The neuropeptide substance P/neurokinin-1 receptor system and diabetes: From mechanism to therapy

Diabetes is a significant public health issue known as the world's fastest-growing disease condition. It is characterized by persistent hyperglycemia and subsequent chronic complications leading to organ dysfunction and, ultimately, the failure of target organs. Substance P (SP) is an undecapeptide that belongs to the family of tachykinin (TK) peptides. The SP-mediated activation of the neurokinin 1 receptor (NK1R) regulates many pathophysiological processes in the body. There is also a relation between the SP/NK1R system and diabetic processes. Importantly, deregulated expression of SP has been reported in diabetes and diabetes-associated chronic complications. SP can induce both diabetogenic and antidiabetogenic effects and thus affect the pathology of diabetes destructively or protectively. Here, we review the current knowledge of the functional relevance of the SP/NK1R system in diabetes pathogenesis and its exploitation for diabetes therapy. A comprehensive understanding of the role of the SP/NK1R system in diabetes is expected to shed further light on developing new therapeutic possibilities for diabetes and its associated chronic conditions.

Clinical features of oral lichen planus and oral lichenoid lesions: an oral pathologist's perspective

The clinicopathological features that precisely characterize oral lichen planus (OLP) and oral lichenoid lesions (OLL) still represent a challenge. The aim of the present study was to analyze, from an oral pathologist perspective, the clinical features from OLP and OLL. Specimens fullfilling the histological criteria for OLP and OLL, and also compatible with OLP (OLP-C), were selected and clinical information was retrieved from the laboratory forms. The final sample was composed by 221 cases, including 119 OLP (53.8%), 65 OLP-C (29.4%) and 37 OLL (16.7%). Females were more affected in the three groups, but the number of males was higher in OLL. Mean age was lower in OLP (52.3 years) in comparison with OLL (57.9 years) (p=0.020). Buccal mucosa and tongue involvement was more frequent in OLP; gingival involvement was uncommon in OLL. The reticular pattern was more frequently found in OLP, while the association of reticular and atrophic/erosive/ulcerated patterns was more common in OLP-C and OLL (p=0.025). In conclusion, gender and mean age of the patients, and anatomical location and clinical manifestation of OLL are different from OLP, and could help to better characterize this group of conditions. Specimens diagnosed as OLP-C showed clinical parameters close to OLP.

Association between oral lichen planus and systemic conditions and medications: Case-control study

OBJECTIVE

The aim of this study is to investigate the association between oral lichen planus (OLP) and a variety of systemic conditions, medication, and supplement usage.

MATERIALS AND METHOD

A total of 156 patients diagnosed with OLP and 156 controls at Columbia University Irving Medical Center from 2000 to 2013 were selected as part of the matched (1:1) case-control study. Demographics, systemic conditions, prescription medications and supplements were extracted from the patients' medical records. A univariable conditional logistic regression (CLR) analysis was performed to calculate unadjusted odds ratio, to identify significant variables associated with OLP (p < .10). Significant variables were further tested using multivariable CLR analysis with both forward and backward selection to calculate adjusted odds ratio (aOR) and further distinguish variables associated with OLP (p < .05).

RESULTS

This analysis identified six significant variables: thyroid disorder (aOR:5.1,95%CI:2.3-11.2), any form of cancer (aOR:3.4,95%CI:1.4-8.4), type 2 diabetes (aOR:2.8,95%CI:1.2-6.3), hyperlipidemia (aOR:2.3,95%CI:1.3-4.1), oral sedative usage (aOR:6.3,95%CI:1.8-22.5), and vitamin D supplementation (aOR:2.7,95%Cl:1.3-6.0).

CONCLUSION

Thyroid disorders, cancer, type 2 diabetes, hyperlipidemia, sedatives, and vitamin D supplementation were found to be associated with OLP. Additional investigation is required to explore these associations, which could shed light on the potential mechanism of OLP and reinforce the idea that oral lesions could be predicative of previously undetected systemic conditions.

Histopathological features of oral lichen planus and its response to corticosteroid therapy: A retrospective study

Oral lichen planus (OLP) exhibits variations in severity and response to corticosteroid therapy. This study aims to assess the histopathological features of OLP at the time of diagnosis and their relationship in response to corticosteroid therapy.In this retrospective study, OLP patients were selected if a histopathological report was available. Data were collected regarding patients' demographics and medical history. Clinical and histological data were also obtained. The outcomes were histopathological findings, clinical form of OLP, number of exacerbations per year, and the response to corticosteroid therapy.In this study, 100 OLP patients were enrolled. Basal layer hydropic degeneration and band-like subepithelial lymphocytes infiltrate were observed in all patients. Plasma cells, identified in 62% of OLP patients, were significantly associated with fewer disease exacerbations and better response to corticosteroid treatment.Identifying histopathological features that may affect the clinical course would be clinically helpful in tailoring patient management.

Correlation between clinical and pathological features of oral lichen planus: A retrospective observational study

Oral lichen planus (OLP) is a common, chronic, inflammatory disease of autoimmune origin. The aim of this study is to determine the correlation of the histopathological features with clinical aspects and variants of OLP.We have retrospectively studied a group of 59 adult patients with confirmed clinical and histopathological diagnosis of OLP from the Oral Pathology Unit of the University of Santiago de Compostela (Spain). Clinical parameters: age, gender, location of the lesions, clinical type, toxic habits, and concomitant treatments were evaluated. Histopathologically, the epithelial response (hyperplasia vs atrophy), presence of ulceration, degree of interface lesion and distribution, intensity, and composition of the inflammatory infiltrate were analyzed.Patients treated with several systemic drugs had more atrophic/erosive forms of OLP (P = .019). Plasma cells were found more commonly in cases showing deep inflammatory involvement of the connective subepithelial tissue than in those where inflammation was only superficially located (P <.001). Their presence was also associated with epithelial erosion-ulceration (P <.01).In conclusion, patients treated with several drugs had more atrophic/erosive forms of OLP and frequently associated with a deep specific inflammatory pattern based on plasma cells. Our results could suggest that drug intake by some patients might confer a supplementary aggravating character to the disease, alone or in conjunction with other non-identified factors. More studies should be carried out to confirm this trend and to assess whether this characteristic, can actually influence the evolution of the lesions.

Oral lichen planus and its relationship with systemic diseases. A review of evidence

BACKGROUND

Oral lichen planus (OLP) is one of the most common dermatological diseases which are present in the oral cavity. It is a chronic autoimmune, mucocutaneous disease that affects the oral mucosa as well as the skin, genital mucosa and other sites.

OBJECTIVE

Review the relevant information to OLP and its relationship with systemic diseases.

MATERIAL AND METHODS

Searches were carried out in the Medline/PubMed, Lilacs, Bireme, BVS, and SciELO databases by using key-words. After an initial search that provided us with 243 papers, this number was reduced to 78 from the last seven years. One of the first criteria adopted was a selective reading of the abstracts of articles for the elimination of publications that presented less information regarding the subject proposed for this work. All the selected articles were read in their entirety by all of the authors, who came to a consensus about their level of evidence. The Scottish Intercollegiate Guidelines Network (SIGN) criteria were used as the criteria of methodological validation.

RESULTS

Only 9 articles showed an evidence level of 1+, 2+, 3 or 4, as well as a recommendation level of A, B, C or D. Three of them were non-systematic reviews, one was a cohort study and only one was a controlled clinical trial. Three of the studies were case series, with respective sample sizes of 45, 171 and 633 patients.

CONCLUSIONS

Several factors have been associated with OLP. Patients with OLP are carriers of a disease with systemic implications and may need the care of a multidisciplinary team. The correct diagnosis of any pathology is critical to making effective treatment and minimizes iatrogenic harm. For OLP is no different, taking into account its association with numerous systemic diseases that require special attention from health professionals. Periodic follow-up of all patients with OLP is recommended. Key words:Oral lichen planus, etiopathogenesis, systemic diseases.

Epstein-Barr Virus–Infected Plasma Cells Infiltrate Erosive Oral Lichen Planus

Epstein-Barr virus (EBV), in addition to its transforming properties, contributes to the pathogenesis of several inflammatory diseases. Here, we investigated its involvement in oral lichen planus (OLP), a common autoimmune-like disease of unknown etiopathogenesis that can display a malignant potential. EBV-infected cells (EBV+ cells) were sought in a large series of clinically representative OLPs ( n = 99) through in situ hybridization to detect small noncoding EBV-encoded RNAs. Overall, our results demonstrated that EBV was commonly found in OLP (74%), with significantly higher frequency (83%) in the erosive form than in the reticular/keratinized type mild form (58%). Strikingly, many erosive OLPs were massively infiltrated by large numbers of EBV+ cells, which could represent a large part of the inflammatory infiltrate. Moreover, the number of EBV+ cells in each OLP section significantly correlated with local inflammatory parameters (OLP activity, infiltrate depth, infiltrate density), suggesting a direct relationship between EBV infection and inflammatory status. Finally, we characterized the nature of the infiltrated EBV+ cells by performing detailed immunohistochemistry profiles ( n = 21). Surprisingly, nearly all EBV+ cells detected in OLP lesions were CD138+ plasma cells (PCs) and more rarely CD20+ B cells. The presence of EBV+ PCs in erosive OLP was associated with profound changes in cytokine expression profile; notably, the expression of key inflammatory factors, such as IL1-β and IL8, were specifically increased in OLP heavily infiltrated with EBV+ PCs. Moreover, electron microscopy–based experiments showed that EBV+ PCs actively produced EBV viral particles, suggesting possible amplification of EBV infection within the lesion. Our study thus brings conclusive evidence showing that OLP is commonly infiltrated with EBV+ PCs, adding a further puzzling element to OLP pathogenesis, given that PCs are now considered to be major regulatory immune cells involved in several autoimmune diseases (ClinicalTrials.gov NCT02276573).

Four cases of mucous membrane pemphigoid with clinical features of oral lichen planus

BACKGROUND

Mucous membrane pemphigoid (MMP) and oral lichen planus (OLP) show similar clinical features on the oral mucosa. As clinical manifestations of oral mucosal lesions, MMP shows blisters and erosions, whereas OLP shows lace-like whitish lesions in an annular arrangement with erythema and erosions. Histopathologically, MMP shows subepithelial bullae with infiltrates of lymphocytes and neutrophils, whereas OLP shows band-like interface infiltration of lymphocytes with damage in basal cells. However, these two diseases are frequently difficult to distinguish both clinically and histopathologically.

OBJECTIVES

We report four patients with oral MMP who showed OLP-like clinical and histopathological lesions.

METHODS

We performed direct immunofluorescence, indirect immunofluorescence of normal human skin and 1 m NaCl-split skin, enzyme-linked immunosorbent assays for BP180, BP230, and desmogleins 1 and 3, and immunoblotting of normal human epidermal and dermal extracts, recombinant proteins of BP180-NC16a and -C-terminal domains, concentrated culture supernatant of HaCaT cells, and purified laminin-332.

RESULTS

The results of various immunological studies suggested the diagnoses of various types of MMP for all four patients.

CONCLUSIONS

Because MMP and OLP require different treatments, all dentists and dermatologists should have knowledge about the disease entity and the serological diagnostic methods for various types of MMP.

Oral lichen planus clinical characteristics in Italian patients: a retrospective analysis

Background

Oral lichen Planus (OLP) is a chronic inflammatory disease involving skin and mucous membranes. Its etiology is still uncertain whilst an autoimmune mechanism is known to be implicated. OLP is commonly considered a geriatric disease and gender differences in prevalence are clear, whereby females are generally more frequently affected than males more often during the 5th and 6th decades of life. Lesions are symmetrical and bilateral and the buccal mucosa is frequently involved. The risk of malignant transformation is extremely low.

This study aims to describe both the clinical characteristics and the prevalence of OLP among a group of patients from Southern Italy. The results of the present study were compared to analogous retrospective studies.

Methods

Eighty-seven (31 man and 56 woman) cases of OLP were retrospectively reviewed and demographic and clinical data were collected. Data about OLP as clinical forms, oral and extraoral sites involved and Visual Analogue Scale were also recorded.

Results

The average age of OLP onset was 59.2 years. The most common clinical presentation was the hyperkeratosic type. Symptomatic OLP was noted in 26.8 % of the patiens. The most frequently affected oral sites were buccal mucosa, tongue, gums. The most frequently associated systemic diseases were diabetes, hypertension, C hepatitis and thyroiditis. Only one patient developed a malignant transformation (1.2 %).

Conclusions

Previous retrospective studies report data partially comparable with our results. Different geographic area, number of enrolled patients and OLP classification criteria may justify the observed differences.

Fractal analysis of mucosal microvascular patterns in oral lichen planus: a preliminary study

OBJECTIVES

The objective of this study was to assess local vascular architecture in atrophic-erosive oral lichen planus (OLP).

MATERIALS AND METHODS

We investigated the capillary structure of the oral mucosa in 31 patients with OLP and 32 healthy controls. Capillaries images were captured in vivo through a capillaroscope. We applied fractal analysis to quantify the microvasculature morphometric changes in the oral mucosa of atrophic-erosive OLP patients in terms of their fractal dimension (D).

RESULTS

The oral vascular networks of atrophic-erosive OLP lesions had a significantly higher D, both in buccal mucosae (D=1.167, P=.019) and in tongue (D=1.196, P=.038), compared with the control population (1.123 for both locations, respectively).

CONCLUSIONS

The present study confirms previous literature data on a close relationship between abnormal vascular architecture and atrophic-erosive OLP. Fractal analysis provided a quantitative descriptor of the complexity of the vascular patterns, which increases in the OLP samples. These data may provide new information on the OLP pathogenesis, as well as serve as morphologic quantifiers for monitoring treatment strategies.

Oral lichen planus (OLP), oral lichenoid lesions (OLL), oral dysplasia, and oral cancer: retrospective analysis of clinicopathological data from 2002-2011

INTRODUCTION

This 10-year retrospective study analyzed the incidence of malignant transformation of oral lichen planus (OLP). The study also included dysplasia and oral lichenoid lesion (OLL) in the initial biopsy as a potential differential diagnosis.

MATERIAL AND METHODS

A total of 692 scalpel biopsies were taken from 542 patients (207 [38.2%] men and 335 [61.8%] women). Clinical and histopathological parameters were analyzed.

RESULTS

The parameters gender (p = 0.022) and smoking behavior (p < 0.001) were significantly associated with the severity of diagnosis. Mucosal lesions with an ulcerative appearance (p = 0.006) and those located on the floor of the mouth (p < 0.001) showed significantly higher degrees of dysplasia or were diagnosed as oral squamous cell carcinoma (OSCC). Smoking and joint disease appeared to be significant risk factors. Treatment with tretinoin in different concentrations (0.005-0.02%) significantly improved diagnosis. Twelve patients (8 female, 4 male) showed malignant transformation to OSCC within an average period of 1.58 years. The malignant transformation rate (MTR) was higher for OLL (4.4%) than OLP (1.2%). If the first biopsy showed intraepithelial neoplasia, the risk of developing OSCC increased (by 3.5% for squamous intraepithelial neoplasia (SIN) II and by 6.7% for SIN III).

CONCLUSION

Although we cannot rule out that OLP is a premalignant oral condition, we can confirm that OLP had the lowest MTR of all diagnoses.

Disease scoring systems for oral lichen planus; a critical appraisal

The aim of the present study has been to critically review 22 disease scoring systems (DSSs) on oral lichen planus (OLP) that have been reported in the literature during the past decades. Although the presently available DSSs may all have some merit, particularly for research purposes, the diversity of both the objective and subjective parameters used in these systems and the lack of acceptance of one of these systems for uniform use, there is a need for an international, authorized consensus meeting on this subject. Because of the natural course of OLP characterized by remissions and exacerbations and also due to the varying distribution pattern and the varying clinical types, e.g. reticular and erosive, the relevance of a DSS based on morphologic parameters is somewhat questionable. Instead, one may consider to only look for a quality of life scoring system adapted for use in OLP patients.

A retrospective study of 171 patients with oral lichen planus in the East Bohemia - Czech Republic - single center experience

Objectives: Oral lichen planus is chronic inflammatory disease with a high prevalence in the population. This study describes the epidemiological and clinical characteristics of group of patients with oral lichen planus in the Czech Republic. Material and Methods: Data was taken from the medical records of 171 patients referred to the Oral Medicine Unit at the University Hospital in Hradec Králové with histologically confirmed clinical diagnosis of oral lichen planus in the period 2003 – 2013. The data were retrospectively reviewed. Results: Of the 171 patients, 116 (67.8%) were women and 55 (32.2%) were men. The mean age was 55.2 ± 12.4 years (range of 85.0 – 20.9). The reticular form was the most frequent 93.6% (160 pts.), desquamative gingivitis was 12.9% (22). The buccal mucosa was the site most affected 89.5% (153 pts.). The lesions were asymptomatic in 52 patients (30.4%). Extraoral lesions were observed in 20.5% (35 pts.) of the patients, skin involvement was in 16.4% (28 pts.). Smokers were 29 patients. Local treatment used 116 (67.8%), only 6 patients used systemic short tome corticoid therapy. No evidence between OLP and malignant transformation was observed. Conclusions: This retrospective study show very similar profile and clinical features of the patients with OLP as in other studies.

Key words:Oral lichen planus, clinical features, extraoral manifestation.

In situ expression and serum level of thymic stromal lymphopoietin in oral lichen planus

BACKGROUND

Oral lichen planus (OLP) is a chronic inflammatory disease of oral mucosa in which the CD8(+) T cell-mediated cytotoxicity is regarded as a major mechanism of pathogenesis. The main objective of this study is to investigate in situ expression and secretion of thymic stromal lymphopoietin (TSLP) in specimens and sera from patients with oral lichen planus.

METHODS

Thirty-six patients with OLP and 35 donors enrolled in specimen and serum collection. Immunohistochemical method and immunofluorescence double-staining method were used to detect the expression of thymic stromal lymphopoietin and its receptor (TSLPR) together with CD8 in OLP specimens. Enzyme-linked immunosorbent assay (ELISA) was used to detect TSLP secretion.

RESULTS

More TSLP- or TSLPR-positive cells showed in OLP specimens than in normal controls, and TSLP-positive cells were mainly in the epithelium, while TSLPR-positive cells mainly in the lamina propria. Furthermore, the number of TSLP-positive cells in the stratum basal was associated with the amount of mononuclear cells infiltrating in the lamina propria of OLP specimens. Among infiltrating mononuclear cells in the lamina propria, some CD8-positive cells also expressed TSLPR. The TSLP serum level of patients with OLP was significantly higher than of healthy donors, but there was no statistically difference between two clinical subtypes of OLP.

CONCLUSIONS

Our findings provided the first evidence that TSLP may enroll in the pathology of OLP and the TSLP-TSLPR interaction may play an important role in it.

Sleep disturbances, anxiety and depression in patients with oral lichen planus: a case-control study

BACKGROUND

The psychological factors and their association with chronic inflammatory disease, aren't well recognized, yet their importance in oral lichen planus is still debated.

AIMS

The aim of this study was to investigate the prevalence of sleep disturbances, anxiety, depression and their association in patient with oral lichen planus.

MATERIALS AND METHODS

50 patients with oral lichen planus vs. equal number of age and sex-matched healthy controls were enrolled. Questionnaires examining insomnia symptoms, excessive daytime sleepiness (Pittsburgh sleep quality index and Epworth aleepiness scale) depression and anxiety (The Hamilton rating scale for Depression and Anxiety) were used.

RESULTS

The patients with oral lichen planus had statistically higher scores in all items of the Pittsburgh sleep quality index, the Hamilton rating scale for depression and anxiety and Epworth sleepiness scale than the healthy controls. The median and inter-quartile range of the Pittsburgh sleep quality index was 5-2 and for the oral lichen planus patients and 4-2 for the healthy controls (P < 0.011). In the study group, a depressed mood and anxiety correlated positively with sleep disturbances. The Pearson correlations were 0.76 for Pittsburgh sleep quality Index vs. Hamilton rating scale for depression (P < 0.001) and 0.77 for Pittsburgh sleep quality Index vs. Hamilton rating scale for anxiety (P < 0.001).

DISCUSSION

Oral lichen planus patients report a greater degree of sleep problems, depressed mood and anxiety as compared with controls.

CONCLUSION

We suggest to screen sleep disturbances in patients with oral lichen planus because they could be considered a prodromal symptoms of mood disorders.

Periodontopathogen profile of healthy and oral lichen planus patients with gingivitis or periodontitis

Oral lichen planus (OLP) is a chronic inflammatory disease that is frequently detected in oral tissues. The aim of our study was to identify the prevalence of the detection of periodontopathogenic microorganisms (Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia and Treponema denticola in OLP patients and to compare with this prevalence of periodontopathogenic microorganisms in healthy non-OLP patients. Our study included 27 (18 chronic periodontitis (OLPP) and 9 gingivitis (OLPG)) patients diagnosed with OLP along with 26 (13 chronic periodontitis (HP) and 13 gingivitis (HG)) healthy non-OLP patients. The multiplex polymerase chain reaction (PCR) with subsequent reverse hybridization method (micro-IDent) was used for identifying periodontopathogenic microorganisms present in subgingival plaque samples. The percentages of detection for A. actinomycetemcomitans, P. gingivalis, P. intermedia, T. forsythia and T. denticola in subgingival plaque samples taken from OLP patients (OLPG and OLPP) were 18.5%, 85.1%, 81.4%, 88.8% and 74%, respectively. Meanwhile, in the non-OLP patients (HG and HP), these values were 7.6%, 50%, 46.1%, 73% and 57.7%, respectively. Thus, comparing the non-OLP groups with the OLP groups, the periodontopathogens' percentages of detection in the OLP groups were higher than those in the non-OLP groups. According to our study results, OLP patients have higher levels of infection with A. actinomycetemcomitans, P. gingivalis, P. intermedia, T. forsythia and T. denticola than non-OLP patients. We argue that the high percentages in patients with OLP may help identify the importance of periodontopathogenic microorganisms in the progress of periodontal diseases of OLP.

A retrospective study of 370 patients with oral lichen planus in Turkey

Objectives: Although several detailed studies concerning the patient profile and clinical features of oral lichen planus have been undertaken all over the world in different populations, a similar study has not yet been conducted in a Turkish population. The purpose of this retrospective study was to describe the demographic and clinical characteristics of a group of patients with oral lichen planus in Turkey. Study Design: Charts of 370 patients, from the archive of Oral Diagnosis and Radiology Department of Marmara University Faculty of Dentistry (Istanbul, Turkey), with histologically confirmed clinical diagnosis of oral lichen planus in the period 1990-2010 were retrospectively reviewed. Results: Of the 370 patients, 260 (70.3%) were women and 110 (29.7%) were men. The mean age was 49.84±13.41 years (range of 16-83). The lesions were asymptomatic in 63 patients (17%). Nearly half of the patients (47.6%) had multiple sites of involvement. Predominantly red forms were the most frequent, affecting 60.5% of patients. Approximately 17% of the patients had symptoms of possible extraoral involvement. No evidence suggesting a connection between oral lichen planus and tobacco or alcohol use was found. Only one out of the 370 cases had histologically proven malignant transformation. Conclusions: The patient profile and clinical features of oral lichen planus in Turkey were generally similar to those described in other populations. The preponderance of the red forms and also the fact that majority of patients referred themselves to our clinic highlighted the lack of awareness among Turkish health care providers about lichen planus.

Key words:Oral lichen planus, clinical features, patient profile.

Oral lichen planus: a retrospective study of 633 patients from Bucharest, Romania

Objective: In this retrospective study, patients’ medical records were reviewed to investigate the profiles of 633 OLP cases in a group of Romania. Material and Methods: In this retrospective study, the following clinical data were obtained from the medical charts of patients: gender, age, clinical presentation of OLP, site affected, presence of symptoms, extraoral manifestations of lichen planus, presence of systemic diseases, and history of medications. Results: Most (78.67%) OLP patients were female and the mean age at presentation was 52 years. The white type of the disease (reticular/papular/plaque lesions) was the main form encountered in this sample (48.97%). Among patients with available hepatitis C virus test results, 9.6% were serum-positive. OLP was associated with gallbladder disease (i.e. cholecystitis, cholelithiasis) in 19% of patients. Six patients (0.95%) developed squamous cell carcinoma at a site with confirmed OLP lesions. Conclusions: To the best of our knowledge, no similar study has been conducted in a Romanian population. The present investigation revealed the predominance of OLP among middle-aged white women and the prevalence of bilateral involvement of the buccal mucosa with reticular white lesions. Anti-HCV circulating antibodies were more common in patients with OLP than in the general population and, notably, OLP was associated with gallbladder disease (cholecystitis, cholelithiasis) in 19% of patients.

Key words:Oral lichen planus, oral mucosal diseases, retrospective study.

Oral lichen planus

Oral lichen planus (OLP) is a relatively common mucosal disease that can present isolated or associated with cutaneous lichen planus. Contrarily to its cutaneous counterpart, though, OLP tends to be chronic, relapsing, and difficult to treat. Severe morbidity is related to erosive forms, and more aggressive presentations have been described, such as the "gingivo-vulvar syndrome". This article reviews the current knowledge about the pathogenesis, clinical picture, differential and laboratorial diagnosis, prognosis, and treatment of OLP.

A retrospective clinicopathological study of 550 patients with oral lichen planus in south-eastern Spain

OBJECTIVES

This study describes the clinicopathological characteristics of a group of patients with oral lichen planus (OLP) in south-eastern Spain.

MATERIALS AND METHODS

A retrospective descriptive study was made of 550 patients clinically and histopathologically diagnosed with OLP in the period 1991-2007. Patient gender, age, the prevalence of hepatitis C, symptoms and malignization were recorded. The clinical forms were classified as reticular-papular and atrophic-erosive.

RESULTS

Of the 550 patients, 128 (23.3%) were men and 422 (76.7%) women. The mean age was 56.35 +/- 13.67 years (range 14-91). The prevalence of hepatitis C was 3.5%. The red clinical forms were the most frequent, with 359 cases (64.2%). The lesions were asymptomatic in 159 patients (28.9%). Five patients developed oral squamous cell carcinoma (0.9%); none of these subjects was smokers.

CONCLUSIONS

Patients with OLP present different clinical manifestations. Women were more frequently affected by the disease, and the malignant transformation rate was under 1%.

Efficacy of Elaeagnus angustifolia Topical Gel in the Treatment of Symptomatic Oral Lichen Planus

Background and aims

The purpose of this study was to determine efficacy of 19% Elaeagnus angustifolia (EA) topical gel in the treatment of symptomatic oral lichen planus.

Materials and methods

Patients with symptomatic oral lichen planus referring to the Department of Oral Medicine, Fac-ulty of Dentistry at Shahid Beheshti University of Medical Sciences were asked to participate in the study. Twenty-eight pa-tients who were histopathologically diagnosed with lichen planus were divided into two groups (15 in the case and 13 in the control groups). The subjects were randomly assigned to either topical gel of EA or placebo in a double-blind manner. They were then instructed to apply the medication on dried lesions three times daily. Pain and size of the lesions were evaluated after 2 weeks. Data were analyzed by SPSS 12.0 software, using t-test, paired t-test, Fisher’s exact test and chi-square test.

Results

Twenty-eight patients (m/f: 7/21) with symptomatic oral lichen planus participated in the study. Fifteen patients (m/f: 4/11) received E A gel and 13 patients (m/f: 3/10) received placebo. There was a 75% decrease in pain (33.3% in the case and 7.7% in the control groups), and a decrease of 50% in size (33.3% in the case group) and 75% only in 7.6% of the case group.

Conclusion

The results suggest that 19% EA gel is efficient in the treatment of symptomatic oral lichen planus, with anti-inflammatory and analgesic effects, as well.

Quantitative analysis of epithelial papillae in patients with oral lichen planus

BACKGROUND

The oral mucosa is relatively vulnerable to pathological processes, and is often affected by autoimmune and malignant diseases. The oral epithelium is normally non-homogeneous, and joins to the connective tissue through interlocking of its downward projections in the form of papillae.

OBJECTIVE

This study aims to conduct a histomorphometric study of the epithelial papillae in patients with oral lichen planus (OLP).

MATERIAL AND METHOD

This study was based on 100 cheek mucosa biopsies from patients with OLP (66 white reticular and 34 atrophic-erosive) (13 males and 87 females, with a mean age of 54.95 +/- 13.64 years). A histological and morphometric evaluation was made, based on imaging analysis with MIP software 4.5 for studying the papillary structure in the patients with OLP.

RESULTS

The mean epithelial thickness was 227.5 +/- 78.5 microm. The different papillary measures--BLS (distance from basal layer to epithelial surface), DPS (distance from dermal papilla top to epithelial surface), DPW (dermal papilla width), and DPD (interdermal papilla distance between two papillae)--yielded no statistically significant differences with respect to age, sex, smoking and clinical form. However, a significant correlation was observed in relation to papilla width and inflammatory infiltrate (P = 0.031).

CONCLUSIONS

The application of this imaging system is useful for measuring variations in epithelial papillary architecture.

Course of oral lichen planus: a retrospective study of 808 northern Italian patients

OBJECTIVES

To undertake a retrospective inspection of the general features, clinical presentation and outcome of 808 Italian patients with oral lichen planus (OLP), followed up from 6 months to 17 years.

RESULTS

The mean age was 61 years for women (n = 493) and 58 years for men (n = 315). More than 20% of the total cases had liver abnormalities (n = 164) of which 83.5% infected with hepatitis C virus (n = 137). The reticular and plaque form were the predominant type, affecting almost 60% of patients. 12.3% of patients had also extraoral manifestation, taking into account the skin (n = 63) and genital (n = 24). Symptoms were present in 40% of the total patients. Only less than 2.47% of patients underwent remission, whereas 78% still had oral lesions at the end of the follow-up period. Treatment was directed towards almost 42% of the patients, mainly using topical corticosteroids. Oral squamous cell carcinoma developed in 15 patients, commonly arising on the lateral border of the tongue.

CONCLUSION

This is one of the largest groups of OLP patients with such long a follow-up ever reported. We confirm the chronic nature of this disorder, rarely remissive and the treatment intend for alleviating symptoms. OLP is established to be a disease with small frequency of malignant transformation.

Osteopontin expression in oral lichen planus

To explore circulation levels of osteopontin (OPN), tumour necrosis factor (TNF)-alpha and transforming growth factor (TGF)-beta1 from patients with oral lichen planus (OLP) for clinical application. A group of 26 subjects with OLP were compared with 26 sex- and age-matched control (NC) subjects. Local lesion tissue was examined for OPN by immunohistochemical analysis. And, serum OPN, proinflammatory TNF-alpha and TGF-beta1 levels were measured by enzyme-linked immunoabsorbent assay. The serum concentrations of OPN and TNF-alpha were significantly higher in OLP patients than the NC group (P < 0.05). Although serum concentrations of TGF-beta1 increased slightly, they were not statistically significant. Erosive-form OLP exhibited significantly elevated TGF-beta1 serum levels, compared with reticular-form OLP. The above results suggest that the production of OPN is associated with the inflammatory process of OLP development, and may serve as a potential disease marker of OLP.

Assessment of the peripheral immunocompetent cells in patients with reticular and atrophic-erosive lichen planus

OBJECTIVE

To assess the cellular and humoral immunity in patients with reticular and atrophic-erosive oral lichen planus (OLP).

STUDY DESIGN

Lymphocyte phenotype analysis of 50 patients with OLP and 16 control subjects was performed by means of flow cytometry. The results were analyzed by the Mann-Whitney U test.

RESULTS

In the patient group the percentage of naïve helper T cells was significantly decreased, while that of memory cells was increased, resulting in a significantly higher ratio of memory to naïve cells in the OLP group than in the control group. In the group of patients with atrophic-erosive OLP, the percentages of cytotoxic/suppressor T cells and cytotoxic/suppressor naïve T cells were found to be slightly decreased.

CONCLUSIONS

The results indicate that the relative ratio of immunocompetent cells in the peripheral blood is altered in patients with lichen planus and that the exact character of these disturbances depends on OLP form. Some of the alterations observed in these patients are typical to autoimmune diseases, thus promoting the concept of autoimmune etiopathogenesis of lichen planus.

High prevalence of glucose metabolism disturbance in patients with lichen planus

AIM

To establish the prevalence of diabetes mellitus (DM) and insulin resistance in patients with lichen planus (LP), and to examine whether diabetic status showed any relation with the type of LP.

PATIENTS AND METHODS

Thirty patients with LP and 30 age, weight, and sex matched volunteers were included. Serum fasting glucose, insulin, hemoglobin A1c levels were determined, a standard oral glucose tolerance test (OGTT) was performed.

RESULTS

Of patients with LP, eight (26.7%) had DM (four newly diagnosed), however, only one (3.33%) diagnosed as DM in control group (p=0.007). Six patients (20.0%) with LP and four healthy persons (13.3%) had IGT (p>0.05). Glucose metabolism disturbance (DM+IGT) was detected in 14 (46.7%) of the patients and in 5 (16.7%) of the controls (p=0.026). HbA1c, fasting serum glucose, and insulin resistance (HOMA) were statistically higher in patients compared to controls.

CONCLUSION

Our finding documented that approximately one half of the patients with LP had glucose metabolism disturbance, and one fourth had DM. We believe that further studies are needed to explain this close relationship between DM and LP.

Gingival Involvement of Oral Lichen Planus

BACKGROUND

Oral lichen planus (OLP) is one of the most common oral mucosa disorders. OLP gingival involvement is very frequently observed and is characterized by a wide range of clinical appearance, symptomatology, and locations. The purpose of this study was to analyze the prevalence and clinical aspects of gingival lesions in a series of 213 patients affected by OLP.

METHODS

We analyzed the prevalence and clinical aspects (location, morphology, and symptomatology) of the gingival lesions in a total of 213 clinically and histopathologically assessed patients affected by OLP.

RESULTS

Gingival lesions were diagnosed in 38.4% of cases. White lesions were the most frequently observed in the gingiva (42.7%), followed by mixed lesions (31.7%), and red lesions (25.6%). For the three clinical forms, the most frequent gingival location was the simultaneous involvement of the attached and marginal gingiva. None of the white lesions presented symptomatology, whereas most red lesions or mixed forms presented symptoms that varied from discomfort to severe oral pain or a burning sensation.

CONCLUSIONS

Considering the high frequency of gingival involvement in OLP, the diversity of clinical manifestations, and its potential relationship with general and oral health in patients, periodontists should be familiar with the most common clinical aspects of OLP in the gingiva.

Triamcinolone acetonide mouth rinses for treatment of erosive oral lichen planus: efficacy and risk of fungal over-infection

OBJECTIVES

To assess the efficacy of triamcinolone acetonide mouthrinse for treatment of erosive oral lichen planus (OLP), and to evaluate the risk of fungal over-infection.

PATIENTS AND METHODS

Clinical records of all cases of erosive and erosive-ulcerative OLP treated in our Oral Medicine Service over the period 1993-2003 were reviewed. All patients had been treated with mouthrinses containing triamcinolone acetonide at 0.3% (T1) or 0.5% (T2). Clinical outcome for each patient was classified at 1, 3 and 6 months after start of treatment as total remission (TR), partial remission (PR) or no remission (NR). Fungal over-infection was also recorded.

RESULTS

A total of 35 cases were included in the study. Clinical outcomes considering both treatment groups together (T1 + T2) were as follows: at month 1, 28.6% TR, 62.9% PR, 8.6% NR; at month 3, 57.1% TR, 37.1% PR, 5.7% NR; and at month 6, 80.0% TR, 17.1% PR, 2.9% NR. In four patients (11.4%) fungal over-infection was noted during the study period.

CONCLUSION

Triamcinolone acetonide mouthrinse is an appropriate treatment for erosive OLP, in view of the high efficacy and low risk of fungal over-infection.

Assessment of local angiogenesis and vascular endothelial growth factor in the patients with atrophic-erosive and reticular oral lichen planus

OBJECTIVES

The objective of this study was to assess local angiogenesis and expression of VEGF in atrophic-erosive and reticular oral lichen planus (OLP).

STUDY DESIGN

Microvessel density (MVD) and VEGF level in 30 OLP subjects and 7 matched controls were detected by immunohistochemistry and ELISA.

RESULTS

MVD and VEGF levels in whole OLP group were significantly elevated (P = .033, P < .0001, respectively), and there was a positive correlation between MVD and VEGF (correlation coefficient = 0.84, P < .0001). MVD in atrophic-erosive OLP was significantly higher than that in controls (P = .001) and reticular OLP (P = .042), and the expression of VEGF in both subgroups was significantly higher (P < .0001, P = .008, respectively) compared to control group.

CONCLUSION

These results indicated that angiogenesis and VEGF expression were closely correlated to the different clinical forms of OLP lesions, which may give new insights into the mechanisms and treatment strategy of OLP.

Scoring system for monitoring oral lichenoid lesions: a preliminary study

BACKGROUND

Currently, there is no universal system for scoring the severity of lichenoid lesions of the oral cavity that is easy to use, reproducible and that is representative of the different clinical forms of the disease.

OBJECTIVES

In this study, a scoring system was developed to monitor the severity of oral lichen planus (OLP) and chronic oral graft-versus-host disease (cGVHD).

METHODS

Six patients with OLP and three with cGVHD were studied. This scoring system was utilized to compare the severity of disease within and between patients. Three investigators independently reviewed photographs taken from each patient and scored the severity of disease. Inter and intra-observer consistency was evaluated using the Spearman rank correlation analyses.

RESULTS

Intra-observer reliability was 0.98 (Spearman correlation coefficient) and inter-observer reliability was 1.00.

CONCLUSION

This scoring system is easy-to-use, reproducible, representative of the severity of the disease and useful for monitoring OLP and cGVHD.

Number V Oral lichen planus: clinical features and management

Oral lichen planus (OLP) is a relatively common chronic inflammatory disorder affecting stratified squamous epithelia. Whereas in the majority of instances, cutaneous lesions of lichen planus (LP) are self-limiting and cause itching, oral lesions in OLP are chronic, rarely undergo spontaneous remission, are potentially premalignant and are often a source of morbidity. Current data suggest that OLP is a T cell-mediated autoimmune disease in which auto-cytotoxic CD8+ T cells trigger apoptosis of oral epithelial cells. The characteristic clinical aspects of OLP may be sufficient to make a correct diagnosis if there are classic skin lesions present. An oral biopsy with histopathologic study is recommended to confirm the clinical diagnosis and mainly to exclude dysplasia and malignancy. The most commonly employed and useful agents for the treatment of lichen planus (LP) are topical corticosteroids but other newer agents are available.

A clinical study of 674 patients with oral lichen planus in China

BACKGROUND

Oral lichen planus (OLP) is a chronic inflammatory disease with different clinical presentations that can be classified as reticular, atrophic or erosive. Although OLP is a relatively common disorder, the reports comprising large numbers of OLP patients with specific character are lacking in the literature. The purpose of this paper was to describe the clinical characteristics of OLP in 674 Chinese patients.

METHODS

A total of 674 charts of patients with histologically confirmed OLP were collected from Stomatological Hospital of Wuhan University between 1963 and 2003.

RESULTS

Of the 674 patients, 65.9% were women and 34.1% were men. The most common clinical presentation was the reticular type (51.3%), and symptomatic OLP was noted in 67.5% of the patients, mainly in those with the erosive form. The erosive presentations showed significantly longer duration, more sites affected and a much greater old patients predominance than reticular or atrophic ones. About 90.9% of the patients had multiple oral sites of involvement and isolated lower lip lichen planus were observed in 60 cases (8.9%) and isolated gingiva lichen in only one case (0.2%). Skin involvement of lichen planus was found in 11.4% of patients. No statistically significant differences could be identified between OLP and diabetes, cardiovascular disease, smoking or alcohol use. Precipitating factors that resulted in an exacerbation of the disease were frequently noted and included foods, stress, dental cusp and poor oral hygiene. The transformation of OLP into malignancy was observed in four patients at sites previously diagnosed by clinical examination as erosive or atrophic lichen planus.

CONCLUSIONS

Patients with OLP in China usually present with distinctive clinical morphology and characteristic distribution and few may display lesions with a confusing array of forms mimicking other diseases. A long time follow up is of utmost importance to detect its malignant transformation.

Plasticity of the different neuropeptide-containing nerve fibres in the tongue of the diabetic rat

Common oral complications of diabetes mellitus are xerostomia, impairment of taste, atrophic lesions of the tongue, leukoplakia, lichen oris planus, and tumours, which might be the consequence of chronic inflammation and changes in innervation. In this work, we examined the density of different neuropeptide-containing nerve fibres immunohisto- and immunocytochemically in the root of the control and diabetic rat's tongue. Quantitative analysis showed that the number of immunoreactive (IR) nerve fibres was decreased after 1 week of the streptozotocin treatment, which was prevented by immediate insulin treatment. However, after 4 weeks duration of diabetes, the number of all investigated IR nerve fibres increased significantly (p<0.05), which was further enhanced by the delayed insulin treatment. The numbers of substance P (SP) and vasoactive intestinal polypeptide IR perikarya were also increased by insulin treatment. The electron-microscopic investigations showed that some of the nerve terminals from diabetic animals were found in degeneration. After 4 weeks duration of diabetes, the number of inflammatory cells as well as the mast cell/nerve fibre contacts was also increased. The immunocells also showed IR for SP and neuropeptide Y in the diabetic rats. The insulin treatment decreased both the number and the immunoreactivity of these cells. The increased synthesis and/or regeneration of neuropeptide-containing nerves might indicate the plasticity of nerve fibres in diabetes mellitus, which might happen as a consequence of the changes in the level of neurotrophic factors released by increased number of inflammatory cells or as an effect of insulin.

Psychosocial stressors in oral lichen planus

BACKGROUND

Psychosomatic factors and their association with dermatological disorders are well recognized, yet their importance in oral lichen planus (OLP) is still debated. This study was done to determine the importance of psychosocial stressors in patients with OLP.

METHODS

An analytical age-sex matched double controlled study. Stratified serial random sampling was done for sample selection. The experimental group consisted of biopsy proven OLP subjects (n = 41), negative control consisted of apparently healthy general Out Patient Department (OPD) patients (n = 73) and positive controls were patients with burning mouth syndrome, atypical facial pain and myofacial pain dysfunction syndrome (n = 36). The General Health Questionnaire-version 28 (GHQ-28) and the Hospital Anxiety and Depression Scale (HADS) were used to evaluate psychosocial stressors in terms of stress, anxiety and depression respectively.

RESULTS

The OLP patients had significantly higher stress (Z = 4.331; p < 0.05, significant), anxiety (Z = 4.260; p < 0.05, significant) and depression levels (Z = 4.942; p < 0.05, significant) than the negative controls when measured by GHQ and HADS respectively. Similar findings were noted between the two control groups, with higher stress (Z = 5.784; p < 0.05, significant), anxiety (Z = 6.416; p < 0.05, significant), and depression (Z = 4.841; p < 0.05, significant) levels in the positive control group. However, differences in stress (Z = 2.0416; p > 0.05, non-significant), anxiety (Z = 1.681; p > 0.05, non-significant) and depression levels (Z = 0.195; p > 0.05, non-significant) were found to be non-significant between OLP and positive control.

CONCLUSION

Significantly higher stress, anxiety and depression levels were found in the OLP and positive control than the general population. No significant difference was noted between the OLP and the positive controls (in which psychosocial stressors are the sole etiology). These suggest that psychological stressors play an important role in the causation of OLP. It may be further hypothesized that these stressors form a starting point for the initiation of various autoimmune reactions, which have been shown to be contributory to the pathogenesis of OLP. Further longitudinal studies need to be done globally before definitive conclusions can be drawn.

Lack of evidence of hepatic disease in patients with oral lichen planus in Serbia

OBJECTIVE

The reported frequency of chronic liver disease, and particularly, Hepatitis C virus (HCV) infection in patients with oral lichen planus (OLP) shows geographical variation. The aim of this study was to determine the prevalence of chronic hepatic disease, Hepatitis B virus and HCV infection in patients with OLP and control subjects resident in Serbia.

PATIENTS AND METHODS

In this prospective study 48 patients with OLP (33 women and 15 men, with a mean age of 49.7 years) and 60 control subjects (38 women and 22 men, with a mean age of 46.7 years) were examined for the presence of serological evidence of chronic hepatic disease, Hepatitis B surface antigen (HBsAg) and anti-HCV seropositivity.

RESULTS

All patients with OLP had normal liver function. HBsAg was not found in any of the patients with OLP or control group. None of the patients with OLP or control subjects were HCV seropositive.

CONCLUSION

Patients with OLP resident in Serbia do not have evidence of chronic liver disease or infection with HBV or HCV. The exact aetiological role between hepatic disease and OLP remains unclear.

Update on diabetes mellitus and related oral diseases

Diabetes mellitus (DM) is a group of complex multisystem metabolic disorders characterized by a relative or absolute insufficiency of insulin secretion and/or concomitant resistance to the metabolic action of insulin on target tissues. The chronic hyperglycaemia of diabetes is associated with long-term systemic dysfunction. The present article summarizes current knowledge of DM and details the oral and dental implications of this common endocrine disorder.

Diagnosis of periodontal manifestations of systemic diseases

Many systemic diseases can mimic periodontitis or gingivitis. These include many immunologic, infectious, neoplastic and metabolic disorders. In comparison with periodontitis and gingivitis, these disorders are considerable less common. However, since their diagnosis and management differ, a high index of suspicion is frequently needed when confronted a patient presenting with gingival or periodontal disease. This chapter has reviewed a number of systemic conditions that may mimic clinically both gingivitis and chronic periodontitis and has focused on the features that may assist the clinician in making the diagnosis and providing specific therapies.

Transformación maligna del liquen plano oral en tres nuevos casos

The possible malignant potential of oral lichen planus (OLP) is still controversial. We present three new oral lichen planus (OLP) patients who developed oral squamous-cell carcinoma (OSCC). In all cases, were analyzed variables like sex, age, clinical type, localization, extension, follow-up study and treatment, moreover were considered the patient's habits, localization, stage and treatment of cancer. The average age was 59 years and both of them were non smoker or with no alcohol habits. The follow-up period was greater than two years and the malignant lesion developed after mean of nine years, after the diagnosis of OLP had been established. Oral squamous-cell carcinoma (OSCC) arose on lesions previously diagnosed clinically and histologically as atrophic and erosive oral lichen planus in two of our patients and on a plaque lesion LP in a patient. All of them had been using topical corticoids before the cancer was diagnosed. The appearance of new cases of OLP malignization framed inside the established approaches, suggests the realization of new researches in order to determine the factors involved in this process.