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González-Moles MÁ, Ramos-García P. Oral lichen planus and related lesions. What should we accept based on the available evidence? Oral Dis 2023; 29:2624-2637. [PMID: 36371653 DOI: 10.1111/odi.14438] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/13/2022] [Accepted: 11/09/2022] [Indexed: 11/15/2022]
Abstract
Recent new terminologies have been proposed for lesions in the sphere of oral lichen planus (OLP) that theoretically present unique aetiological, clinical, prognostic or management characteristics different from those of the so-called typical forms of OLP. We aimed to critically analyse what concepts and terminologies related to OLP should we accept based on the available evidence. A review of the literature was carried out in order to critically analyse the concepts and terminologies related to OLP. New concepts and terminologies include oral lichenoid lesions; contact lichenoid reactions, drug lichenoid reactions or those in the context of graft-versus-host disease; chronic ulcerative stomatitis; lichen planus pemphigoid; and some lesions that are difficult to categorise, such as OLP with features of proliferative verrucous leukoplakia and lichenoid lesions of the upper labial mucosa. A multidisciplinary, multicontinent working group has recently published a guideline with recommendations for modifying definitions and terminologies associated with a disease, among which a reasoned, evidence-based justification for the proposed change is considered essential. An in-depth analysis of the newly proposed terms for OLP-related lesions shows that many of them are not justified. In this paper, we set out our position on the basis of the existing evidence on the appropriateness of the use of these new terms.
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Affiliation(s)
| | - Pablo Ramos-García
- School of Dentistry, Biohealth Research Institute (Ibs.Granada), University of Granada, Granada, Spain
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2
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Islam NM, Alramadhan SA. Lichenoid Lesions of the Oral Mucosa. Oral Maxillofac Surg Clin North Am 2023; 35:189-202. [PMID: 36805899 DOI: 10.1016/j.coms.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Lichenoid lesions involving the oral cavity present with an array of complex clinical manifestations and etiologies. The etiology ranges from local factors, systemic entities, and even autoimmune conditions. Several different types of lichenoid lesions may affect the oral cavity, and it is imperative that these are correctly diagnosed to ensure effective patient care. Lichenoid lesions such as chronic ulcerative stomatitis prove to be challenging as these are recalcitrant, present with overlapping features, require unique treatment and patients suffer a long time if not promptly diagnosed.
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Affiliation(s)
- Nadim M Islam
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, 1395 Center Drive, Gainesville, FL 32610, USA.
| | - Saja A Alramadhan
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, 1395 Center Drive, Gainesville, FL 32610, USA
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3
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Cichońska D, Komandera D, Mazuś M, Kusiak A. Chronic Ulcerative Stomatitis (CUS) as an Interdisciplinary Diagnostic Challenge: A Literature Review. Int J Mol Sci 2022; 23:ijms232213772. [PMID: 36430253 PMCID: PMC9692827 DOI: 10.3390/ijms232213772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/03/2022] [Accepted: 11/07/2022] [Indexed: 11/12/2022] Open
Abstract
Chronic ulcerative stomatitis (CUS) is a rarely reported disease affecting the oral cavity, most often affecting middle-aged Caucasian females. The aim of the present study is to present the diagnosis, differentiation, and interdisciplinary treatment of this rare disease. CUS is characterized by the presence of an oral erosive or ulcerative lesion. The autoimmune pathogenesis of CUS includes affecting the antigen's activity by DNA-breaking and protein-hydrolyzing enzymes. The stratified epithelium-specific antinuclear antibodies (SES-ANA) are associated with CUS development. Clinically, the lesions presented in oral mucosa might resemble an erosive form of oral lichen planus, whereas gingival lesions seem to be similar to desquamative gingivitis related to dermatological diseases manifested in the oral cavity. Patients often report subjective symptoms related to oral mucosa and general symptoms. Histopathological presentation of CUS is often non-specific and includes sub-epithelial separation from underlying connective tissue, atrophic epithelium, and inflammatory infiltrate with an increased number of plasma cells and lymphocytes. Direct immunofluorescence (DIF) might be used in CUS diagnostics. CUS generally remains nonsusceptible to corticosteroid treatments; however, antimalarial drugs and calcineurin inhibitors are more effective. Further research should be conducted in order to implement a diagnostic protocol and observe the long-term results of CUS management.
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Affiliation(s)
- Dominika Cichońska
- Department of Periodontology and Oral Mucosa Diseases, Medical University of Gdansk, 80-200 Gdansk, Poland
- Correspondence:
| | - Dominika Komandera
- Student Research Group at the Department of Periodontology and Oral Mucosa Diseases, Medical University of Gdansk, 80-200 Gdansk, Poland
| | - Magda Mazuś
- Student Research Group at the Department of Periodontology and Oral Mucosa Diseases, Medical University of Gdansk, 80-200 Gdansk, Poland
| | - Aida Kusiak
- Department of Periodontology and Oral Mucosa Diseases, Medical University of Gdansk, 80-200 Gdansk, Poland
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4
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Schroeder F, Palma V, Rados P, Visioli F. Clinical and immunological features of chronic ulcerative stomatitis: a systematic review. J Oral Pathol Med 2022; 51:501-509. [DOI: 10.1111/jop.13279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/14/2021] [Accepted: 01/06/2022] [Indexed: 11/27/2022]
Affiliation(s)
- F.M.M. Schroeder
- Oral Medicine Department School of Dentistry Universidade Federal do Rio Grande do Sul Porto Alegre RS Brazil 90035‐003
| | - V.M. Palma
- Oral Medicine Department School of Dentistry Universidade Federal do Rio Grande do Sul Porto Alegre RS Brazil 90035‐003
| | - P.V. Rados
- Oral Medicine Department School of Dentistry Universidade Federal do Rio Grande do Sul Porto Alegre RS Brazil 90035‐003
| | - F. Visioli
- Oral Medicine Department School of Dentistry Universidade Federal do Rio Grande do Sul Porto Alegre RS Brazil 90035‐003
- Experimental Center Research Hospital de Clínicas de Porto Alegre Porto Alegre RS Brazil 90035‐903
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5
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Herzum A, Burlando M, Cozzani E, Parodi A. The 30th birthday of chronic ulcerative stomatitis: A systematic review. Int J Immunopathol Pharmacol 2021; 35:20587384211052437. [PMID: 34666534 PMCID: PMC8532222 DOI: 10.1177/20587384211052437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Chronic ulcerative stomatitis (CUS) is a chronic, ulcerative condition of the oral cavity, clinically and histologically similar to oral lichen planus (OLP), first described as a new disease entity in 1990 by Parodi et al. In this review, 30 years after our first description of CUS, we aimed to systematically review the literature of CUS cases reported ever since. METHODS We present a systematic review of CUS literature cases, performed in compliance with the PRISMA statement. RESULTS Of 125 retrieved articles, 20 satisfied inclusion criteria. These described 76 CUS cases, all presenting orally evident disease: erosions (55%), white lesions (49%), erythema (49%), ulcerations (34%) were the most frequent signs; 54% experienced discomfort/pain. Topographically, buccal mucosa (68%) and gingiva (54%) were the most affected locations, followed by tongue (42%), hard palate (27%), labial mucosa (22%), and widespread involvement (15%). Great diagnostic delay (6.3 years) was evidenced highlighting CUS is an entity too often misdiagnosed. Histopathology found lichenoid features (46%) and non-specific inflammation (54%). Extra-oral involvement was reported in 21%, especially as LP (69%). Of DIF, 97% were positive; 3% negative, compensated by positive IIF, permitting diagnosis. Of patients on steroids, only 12% reported therapeutic success; most steroid-non-responsive patients passed to antimalarials, with 91.66% success when used alone, 100% success in combination therapy. CONCLUSION Dermatologists should suspect CUS in chronic steroid-unresponsive erosive/ulcerative stomatitis. In these cases, to diagnose CUS, the presence of stratified epithelium-specific antinuclear antibodies (SES-ANA) should be investigated through immunofluorescence. Once diagnosed, CUS can be treated with antimalarials, which are an effective treatment contrarily to corticosteroids.
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Affiliation(s)
- Astrid Herzum
- DISSAL, Section of Dermatology, 9246Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Martina Burlando
- DISSAL, Section of Dermatology, 9246Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Emanuele Cozzani
- DISSAL, Section of Dermatology, 9246Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Aurora Parodi
- DISSAL, Section of Dermatology, 9246Ospedale Policlinico San Martino IRCCS, Genova, Italy
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6
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Hussein H, Brown R. Hydroxychloroquine and the treatment of Sjogren syndrome, chronic ulcerative stomatitis, and oral lichen planus in the age of COVID-19. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 131:e9-e13. [PMID: 32654931 PMCID: PMC7305926 DOI: 10.1016/j.oooo.2020.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/01/2020] [Accepted: 06/10/2020] [Indexed: 12/12/2022]
Abstract
The Food and Drug Administration has recently approved the off-label use of hydroxychloroquine (HCQ) for the treatment of coronavirus disease 2019 (COVID-19) infections. However, a recent study not only failed to demonstrate HCQ efficacy but also documented a serious side effect of COVID-19 therapy with HCQ: QT prolongation and secondary arrhythmia. HCQ has been used as an off-label drug and deemed safe and effective for the treatment of oral lesions, such as Sjogren syndrome (SS), chronic ulcerative stomatitis (CUS), and oral lichen planus (OLP). Because HCQ may be appropriately used for the off-label treatment of SS, CUS, and OLP, relevant safety concerns regarding HCQ therapy with regard to dosage, drug-to-drug interactions, and QT prolongation and secondary arrhythmia are discussed here. Because of the possibility of decreased pharmacy supplies of HCQ, replacement drugs with respect to patients with SS, CUS, and OLP being successfully treated with HCQ are also discussed.
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Affiliation(s)
- Heba Hussein
- Department of Oral Medicine, Diagnosis, and Periodontology, Faculty of Dentistry, Cairo University, Cairo
| | - Ronald Brown
- Department of Oral Diagnosis & Radiology, Howard University College of Dentistry, Washington, DC; Department of Otolaryngology, Georgetown University Medical Center, Washington, DC.
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7
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Brown R. Hydroxychloroquine and "off-label" utilization in the treatment of oral conditions. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 129:643-644. [PMID: 32331804 PMCID: PMC7151388 DOI: 10.1016/j.oooo.2020.03.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 03/27/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Ronald Brown
- Howard University College of Dentistry, Department of Oral Diagnosis & Radiology, Washington, DC United States.
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8
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Carrozzo M, Porter S, Mercadante V, Fedele S. Oral lichen planus: A disease or a spectrum of tissue reactions? Types, causes, diagnostic algorhythms, prognosis, management strategies. Periodontol 2000 2019; 80:105-125. [PMID: 31090143 DOI: 10.1111/prd.12260] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Oral lichen planus and lichenoid lesions comprise a group of disorders of the oral mucosa that likely represent a common reaction pattern to 1 or more unknown antigens. The coexistence of hyperkeratotic striation/reticulation, varying degrees of mucosal inflammation from mild erythema to severe widespread ulceration, and a band-like infiltrate of mononuclear inflammatory cells including activated T lymphocytes, macrophages, and dendritic cells, are considered suggestive of oral lichen planus and lichenoid lesions. Several classification systems of oral lichen planus and lichenoid lesions have been attempted, although none seem to be comprehensive. In this paper, we present a classification of oral lichen planus and lichenoid lesions that includes oral lichen planus, oral lichenoid contact lesions, oral lichenoid drug reactions, oral lichenoid lesions of graft vs. host disease, discoid lupus erythematosus, and systemic lupus erythematosus, lichen planus-like variant of paraneoplastic pemphigus/paraneoplastic autoimmune multiorgan syndrome, chronic ulcerative stomatitis, lichen planus pemphigoides, solitary fixed drug eruptions, and lichen sclerosus. We present the clinical and diagnostic aspects of oral lichen planus and lichenoid lesions, and discuss related treatment options.
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Affiliation(s)
- Marco Carrozzo
- Centre for Oral Health Research, Oral Medicine Department, Newcastle University, Newcastle upon Tyne, UK
| | - Stephen Porter
- UCL Eastman Dental Institute, University College London, London, UK
| | | | - Stefano Fedele
- UCL Eastman Dental Institute, University College London, London, UK.,NIHR University College London Hospitals Biomedical Research Centre, London, UK
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9
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Ferrisse TM, Travassos DC, Rocha AF, Massucato EM, Bufalino A. Chronic ulcerative stomatitis: A systematic review of the clinical and microscopic features. Med Oral Patol Oral Cir Bucal 2019; 24:e698-e703. [PMID: 31655827 PMCID: PMC6901147 DOI: 10.4317/medoral.22213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 05/01/2018] [Indexed: 11/12/2022] Open
Abstract
Background the purpose of this study was to perform a systematic review regarding clinical and histopathological characteristics, immunopathological findings, and treatment for chronic ulcerative stomatitis (CUS).
Material and Methods articles in English, published from January 1962 up to November 2017, assessing clinical and immunological features, treatment, and follow-up of patientes with CUS, were retrieved from three databases (PubMed, Cochrane Library and SCOPUS). A manual literature search was also conducted. A total of 12 studies met inclusion criteria, therefore, were analyzed in this review.
Results CUS shares similiar clinical and microscopic features to those found in oral lichen planus (OLP) and oral lichenoid lesions (OLL). Hence, direct immunofluorescence (DIF) is indispensable to define a final diagnosis. Due to the poor sample availability in the current literature, it is not possible to accurately confirm the prevalence and features of CUS.
Conclusions in order to better evaluate this condition’s findings, further studies with a greater amount of similar immune-mediated diseases should be performed. Key words:Chronic ulcerative stomatitis, immune-mediated diseases, immunofluorescence, lichen planus.
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Affiliation(s)
- T-M Ferrisse
- Department of Diagnosis and Surgery Univ Estadual Paulista (UNESP) CEP 14801-903, Araraquara, Sao Paulo, Brazil
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10
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Hakeem A, Bhattacharyya I, Aljabri M, Bindakhil M, Pachigar K, Islam MN, Cohen DM, Fitzpatrick SG. Lichenoid reaction with granulomatous stomatitis: A retrospective histologic study of 47 patients. J Oral Pathol Med 2019; 48:846-854. [PMID: 31228223 DOI: 10.1111/jop.12918] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/20/2019] [Accepted: 05/30/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Lichenoid granulomatous reaction can be subcategorized into lichenoid granulomatous dermatitis or lichenoid granulomatous stomatitis. It is described in the literature as demonstrating a band-like lichenoid infiltration with clusters of histiocytic or granuloma formation. In this study, we presented a large case series of lichenoid granulomatous stomatitis including demographics, histological features, and subcategories and compared findings with current literature. METHODS AND MATERIALS We retrieved all cases diagnosed with lichenoid reaction with granulomatous inflammation between January 1, 2000, and August 1, 2016, from the University of Florida Oral Pathology Biopsy Service Archives. RESULTS A total of 47 patients with tissue from 50 biopsy sites were included. The majority of the cases were noted in females (64%) with a mean age of 59 years (range 30-88). Most patients were Caucasian, and the most common sites in descending order were: gingiva, buccal mucosa, vestibule, tongue, lip, palate, and occasional multifocal involvement. Clinical impressions by the treating clinicians included leukoplakia, dysplasia, carcinoma in situ, squamous cell carcinoma, lichen planus, vesiculobullous disease, trauma, and allergy. The histologic features of these cases ranged from lichenoid mucositis with numerous aggregates of histiocytes to well-formed granulomas, in accordance with previous classifications of similar dermatologic lesions. All cases revealed positive CD 68 in the histiocytic infiltrates and were negative for microorganisms utilizing acid-fast bacilli, Grocott methenamine-silver, and periodic acid-Schiff stains. CONCLUSION Lichenoid granulomatous disease may be more common than previously reported; however, its etiology remains unknown and patients should be kept under long-term clinical follow-up.
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Affiliation(s)
- Abdulaziz Hakeem
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Indraneel Bhattacharyya
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Mohammed Aljabri
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Mohammed Bindakhil
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Krunal Pachigar
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Mohammed N Islam
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Donald M Cohen
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Sarah G Fitzpatrick
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
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11
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Azzi L, Cerati M, Lombardo M, Pellilli M, Croveri F, Maurino V, Tagliabue A, Tettamanti L, Olszewska M. Chronic ulcerative stomatitis: A comprehensive review and proposal for diagnostic criteria. Oral Dis 2019; 25:1465-1491. [PMID: 30457193 DOI: 10.1111/odi.13001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 09/23/2018] [Accepted: 10/11/2018] [Indexed: 11/29/2022]
Abstract
Chronic ulcerative stomatitis (CUS) is an immune-mediated disorder characterized by oral erosions and ulcers usually refractory to conventional treatments. The disease often involves middle-aged and older women with painful lesions sometimes resembling those of erosive oral lichen planus (OLP). The most affected sites are the buccal mucosa, the gingiva and the tongue, but the skin is involved in 22.5% of cases. Histopathologic features in CUS are non-specific and indistinguishable from those of OLP, with the exception of the presence of a mixed infiltrate composed of lymphocytes and plasma cells. Direct immunofluorescence (DIF) analysis reveals the presence of stratified epithelium-specific antinuclear antibodies (SES-ANA) in the lower third of the epithelium. The IgG antibodies detected on DIF are directed against the ∆Np63α isoform of p63 expressed in the nuclei of the epithelial basal cells. A distinguishing feature of CUS is the low response to conventional corticosteroid therapy and the good outcome with hydroxychloroquine at the dosage of 200 mg/day or higher dosages. This paper presents a comprehensive review of CUS and is accompanied by a new case report (the 73rd case) and a proposal for updated diagnostic criteria.
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Affiliation(s)
- Lorenzo Azzi
- Unit of Oral Pathology, Dental Clinic, ASST Sette Laghi, Ospedale di Circolo, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Michele Cerati
- Unit of Anatomical Pathology, ASST Sette Laghi, Ospedale di Circolo, Varese, Italy
| | - Maurizio Lombardo
- Unit of Dermatological Diseases, ASST Sette Laghi, Ospedale di Circolo, Varese, Italy
| | - Maria Pellilli
- Unit of Anatomical Pathology, ASST Sette Laghi, Ospedale di Circolo, Varese, Italy
| | - Fabio Croveri
- Unit of Oral Pathology, Dental Clinic, ASST Sette Laghi, Ospedale di Circolo, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Vittorio Maurino
- Unit of Oral Pathology, Dental Clinic, ASST Sette Laghi, Ospedale di Circolo, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Angelo Tagliabue
- Unit of Oral Pathology, Dental Clinic, ASST Sette Laghi, Ospedale di Circolo, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Lucia Tettamanti
- Unit of Oral Pathology, Dental Clinic, ASST Sette Laghi, Ospedale di Circolo, Department of Medicine and Surgery, University of Insubria, Varese, Italy
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12
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Seventeen New Cases of Chronic Ulcerative Stomatitis with Literature Review. Head Neck Pathol 2018; 13:386-396. [PMID: 30374883 PMCID: PMC6684677 DOI: 10.1007/s12105-018-0982-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/26/2018] [Indexed: 10/28/2022]
Abstract
Chronic ulcerative stomatitis (CUS) is a poorly understood disease with clinical and histologic overlap with lichen planus (LP). Unlike classic LP, direct immunofluorescence (DIF) studies in cases of CUS exhibit a granular pattern of IgG in nuclei of basal and parabasal cells. This study assesses the demographic, clinical, histologic, and DIF features of CUS. It is important to differentiate CUS from LP and other vesiculobullous diseases (VBD) because lesions of CUS are resistant to steroid therapy, which is typically used to control LP and VBD. A literature review and IRB-approved retrospective search of CUS was performed within the archives of the University of Florida (UF) Oral Pathology Biopsy Service from 2007 to 2017. Fifty-two cases were identified from the literature and seventeen new cases were identified in our series. All UF patients were female and the median age was 64-years. The majority of patients were Caucasian and the most common location was buccal mucosa. Frequent clinical presentations were pain, erythema, leukoplakia, and ulcerations. Histologic features included epithelial separation, atrophic epithelium, and a chronic inflammatory infiltrate. All cases were confirmed with DIF testing that showed a speckled pattern of IgG staining in basal and parabasal cell nuclei. Fibrinogen was present in eleven cases and two cases were positive for C3. The results of our series are in accordance with the literature. Since CUS has overlapping features with LP and VBD, clinicians and pathologists should consider this entity and confirm diagnosis with DIF testing when recalcitrant oral ulcerative diseases are encountered.
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13
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Ko EM, Danciu TE, Fullen DR, Chan MP. Chronic ulcerative stomatitis: Case series of an under-recognized entity. J Cutan Pathol 2018; 45:927-932. [DOI: 10.1111/cup.13347] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 08/14/2018] [Accepted: 08/28/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Eugene M. Ko
- Department of Periodontics and Oral Medicine, School of Dentistry; University of Michigan; Ann Arbor Michigan
- Department of Oral Medicine, School of Dental Medicine; University of Pennsylvania; Philadelphia Pennsylvania
| | - Theodora E. Danciu
- Department of Periodontics and Oral Medicine, School of Dentistry; University of Michigan; Ann Arbor Michigan
| | - Douglas R. Fullen
- Department of Pathology; University of Michigan; Ann Arbor Michigan
- Department of Dermatology; University of Michigan; Ann Arbor Michigan
| | - May P. Chan
- Department of Pathology; University of Michigan; Ann Arbor Michigan
- Department of Dermatology; University of Michigan; Ann Arbor Michigan
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14
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Cizenski JD, Michel P, Watson IT, Frieder J, Wilder EG, Wright JM, Menter MA. Spectrum of orocutaneous disease associations: Immune-mediated conditions. J Am Acad Dermatol 2017; 77:795-806. [PMID: 29029901 DOI: 10.1016/j.jaad.2017.02.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/01/2017] [Accepted: 02/03/2017] [Indexed: 02/07/2023]
Abstract
There are a number of diseases that manifest both on the skin and the oral mucosa, and therefore the importance for dermatologists in clinical practice to be aware of these associations is paramount. In the following continuing medical education series, we outline orocutaneous disease associations with both immunologic and inflammatory etiologies.
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Affiliation(s)
- Jeffrey D Cizenski
- Division of Dermatology, Baylor University Medical Center, Dallas, Texas
| | - Pablo Michel
- Division of Dermatology, Baylor University Medical Center, Dallas, Texas
| | - Ian T Watson
- Texas A&M Health Science Center College of Medicine, Bryan, Texas
| | - Jillian Frieder
- Division of Dermatology, Baylor University Medical Center, Dallas, Texas
| | - Elizabeth G Wilder
- Division of Dermatology, Baylor University Medical Center, Dallas, Texas
| | - John M Wright
- Department of Diagnostic Sciences, Texas A&M College of Dentistry, Dallas, Texas
| | - M Alan Menter
- Division of Dermatology, Baylor University Medical Center, Dallas, Texas.
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15
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Clinicopathologic significance of in vivo antinuclear autoantibodies in oral mucosal biopsies. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 124:475-482. [PMID: 28939244 DOI: 10.1016/j.oooo.2017.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 08/08/2017] [Accepted: 08/10/2017] [Indexed: 10/19/2022]
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16
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Feller L, Khammissa RAG, Lemmer J. Is chronic ulcerative stomatitis a variant of lichen planus, or a distinct disease? J Oral Pathol Med 2017; 46:859-863. [PMID: 28186659 DOI: 10.1111/jop.12561] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2017] [Indexed: 12/31/2022]
Abstract
Chronic ulcerative stomatitis is an immune-mediated mucocutaneous disorder characterized clinically by erosions or ulcers. Most cases are limited to the mouth. The histopathological features are non-specific or mimic those of oral lichen planus, and studies by immunofluorescent microscopy are essential for definitive diagnosis. The defining immunopathogenic mechanism is the binding of IgG to the nuclear protein deltaNp63alpha of keratinocytes in the basal and parabasal cell layers of the oral stratified epithelium. DeltaNp63alpha functions as a regulator of epithelial stem cell activity and as an antiapoptotic agent and regulates the expression of cell-to-cell and cell-to-basement membrane adhesion molecules. The autoimmune IgG-deltaNp63alpha interaction is thought to result in damage to the structural attachment of keratinocytes to one another and to the epithelial basement membrane zone and in dysregulation of the cell cycle and apoptosis of basal keratinocytes with the development of erosions or ulcers. The aims of treatment are to suppress the pathogenic immunoinflammatory responses, to prevent local infection and to promote healing. The purpose of this article is to provide a succinct review of the diagnostic, clinical and etiopathogenic features of, and treatment guidelines for chronic ulcerative stomatitis, and to argue that this disease should be regarded as a variant of oral lichen planus, rather than as a distinct entity.
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Affiliation(s)
- Liviu Feller
- Department of Periodontology and Oral Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Razia A G Khammissa
- Department of Periodontology and Oral Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Johan Lemmer
- Department of Periodontology and Oral Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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17
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Oral lichenoid lesions: distinguishing the benign from the deadly. Mod Pathol 2017; 30:S54-S67. [PMID: 28060366 DOI: 10.1038/modpathol.2016.121] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 05/31/2016] [Accepted: 06/02/2016] [Indexed: 12/25/2022]
Abstract
Oral lichen planus is a chronic inflammatory disease of unknown etiology or pathogenesis with varied disease severity that waxes and wanes over a long period of time. Although a common oral mucosal disease, accurate diagnosis is often challenging due to the overlapping clinical and histopathological features of oral lichen planus and other mucosal diseases. Other immune-mediated mucocutaneous diseases can exhibit lichenoid features including mucous membrane pemphigoid, chronic graft-versus-host disease, and discoid lupus erythematosus. Reactive changes to dental materials or to systemic medications can mimic oral lichen planus both clinically and histologically. In these situations the clinical presentation can be useful, as oral lichen planus presents as a multifocal process and is usually symmetrical and bilateral. Dysplasia of the oral cavity can exhibit a lichenoid histology, which may mask the potentially premalignant features. Proliferative verrucous leukoplakia, an unusual clinical disease, can often mimic oral lichen planus clinically, requiring careful correlation of the clinical and pathologic features.
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18
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Cheng YSL, Gould A, Kurago Z, Fantasia J, Muller S. Diagnosis of oral lichen planus: a position paper of the American Academy of Oral and Maxillofacial Pathology. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 122:332-54. [PMID: 27401683 DOI: 10.1016/j.oooo.2016.05.004] [Citation(s) in RCA: 278] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/03/2016] [Accepted: 05/11/2016] [Indexed: 12/26/2022]
Abstract
Despite being one of the most common oral mucosal diseases and recognized as early as 1866, oral lichen planus (OLP) is still a disease without a clear etiology or pathogenesis, and with uncertain premalignant potential. More research is urgently needed; however, the research material must be based on an accurate diagnosis. Accurate identification of OLP is often challenging, mandating inclusion of clinico-pathological correlation in the diagnostic process. This article summarizes current knowledge regarding OLP, discusses the challenges of making an accurate diagnosis, and proposes a new set of diagnostic criteria upon which to base future research studies. A checklist is also recommended for clinicians to provide specific information to pathologists when submitting biopsy material. The diagnostic process of OLP requires continued clinical follow-up after initial biopsy, because OLP mimics can manifest, necessitating an additional biopsy for direct immunofluorescence study and/or histopathological evaluation in order to reach a final diagnosis.
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Affiliation(s)
- Yi-Shing Lisa Cheng
- Department of Diagnostic Sciences, Texas A&M University College of Dentistry, Dallas, TX, USA.
| | - Alan Gould
- Louisville Oral Pathology Laboratory, Louisville, KY, USA
| | - Zoya Kurago
- Department of Oral Health and Diagnostic Sciences, College of Dental Medicine, Augusta University, Augusta, GA, USA
| | - John Fantasia
- Department of Dental Medicine, Hofstra North Shore-Long Island Jewish Health System, New Hyde Park, NY, USA
| | - Susan Muller
- Professor Emeritus, Emory University School of Medicine, Atlanta, GA; Atlanta Oral Pathology, Decatur, GA, USA
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19
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Thongprasom K, Prapinjumrune C, Kanjanabuch P, Youngnak-Piboonratanakit P, Preuksrisakul T. Correlation of serum ANA and direct immunofluorescence studies in elderly Thai patients with red and white oral lesions. J Oral Pathol Med 2016; 45:797-802. [DOI: 10.1111/jop.12444] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2016] [Indexed: 01/13/2023]
Affiliation(s)
- Kobkan Thongprasom
- Oral Medicine Department; Faculty of Dentistry; Chulalongkorn University; Bangkok Thailand
| | - Chanwit Prapinjumrune
- Oral Medicine Department; Faculty of Dentistry; Chulalongkorn University; Bangkok Thailand
| | - Patnarin Kanjanabuch
- Oral Medicine Department; Faculty of Dentistry; Chulalongkorn University; Bangkok Thailand
| | | | - Titipong Preuksrisakul
- Oral Medicine Department; Faculty of Dentistry; Chulalongkorn University; Bangkok Thailand
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20
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Qari H, Villasante C, Richert J, Rees T, Kessler H. The diagnostic challenges of separating chronic ulcerative stomatitis from oral lichen planus. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 120:622-7. [DOI: 10.1016/j.oooo.2015.07.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 07/03/2015] [Accepted: 07/13/2015] [Indexed: 11/16/2022]
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21
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Mustafa MB, Porter SR, Smoller BR, Sitaru C. Oral mucosal manifestations of autoimmune skin diseases. Autoimmun Rev 2015; 14:930-51. [PMID: 26117595 DOI: 10.1016/j.autrev.2015.06.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 06/16/2015] [Indexed: 02/06/2023]
Abstract
A group of autoimmune diseases is characterised by autoantibodies against epithelial adhesion structures and/or tissue-tropic lymphocytes driving inflammatory processes resulting in specific pathology at the mucosal surfaces and the skin. The most frequent site of mucosal involvement in autoimmune diseases is the oral cavity. Broadly, these diseases include conditions affecting the cell-cell adhesion causing intra-epithelial blistering and those where autoantibodies or infiltration lymphocytes cause a loss of cell-matrix adhesion or interface inflammation. Clinically, patients present with blistering, erosions and ulcers that may affect the skin as well as further mucosal surfaces of the eyes, nose and genitalia. While the autoimmune disease may be suspected based on clinical manifestations, demonstration of tissue-bound and circulating autoantibodies, or lymphocytic infiltrates, by various methods including histological examination, direct and indirect immunofluorescence microscopy, immunoblotting and quantitative immunoassay is a prerequisite for definitive diagnosis. Given the frequency of oral involvement and the fact that oral mucosa is the initially affected site in many cases, the informed practitioner should be well acquainted with diagnostic and therapeutic aspects of autoimmune dermatosis with oral involvement. This paper reviews the pathogenesis and clinical presentation of these conditions in the oral cavity with a specific emphasis on their differential diagnosis and current management approaches.
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Affiliation(s)
- Mayson B Mustafa
- Department of Dermatology, University of Freiburg, Hauptstrasse 7, 79104 Freiburg, Germany; Oral medicine section, Department of Oral and Maxillofacial Surgery, University of Khartoum, Faculty of Dentistry, Khartoum, Sudan
| | | | - Bruce R Smoller
- Department of Pathology, University of Rochester, School of Medicine and Dentistry, USA
| | - Cassian Sitaru
- Department of Dermatology, University of Freiburg, Hauptstrasse 7, 79104 Freiburg, Germany; BIOSS Centre for Biological Signalling Studies, Signalhaus Freiburg, Schänzlestr. 18, 79104 Freiburg, Germany.
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22
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Prucktrakul C, Youngnak-Piboonratanakit P, Kanjanabuch P, Prueksrisakul T, Thongprasom K. Oral lichenoid lesions and serum antinuclear antibodies in Thai patients. J Oral Pathol Med 2014; 44:468-74. [DOI: 10.1111/jop.12257] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2014] [Indexed: 12/11/2022]
Affiliation(s)
- Chalakorn Prucktrakul
- Oral Medicine Department, Faculty of Dentistry; Chulalongkorn University; Bangkok Thailand
| | | | - Patnarin Kanjanabuch
- Oral Medicine Department, Faculty of Dentistry; Chulalongkorn University; Bangkok Thailand
| | - Titipong Prueksrisakul
- Oral Medicine Department, Faculty of Dentistry; Chulalongkorn University; Bangkok Thailand
| | - Kobkan Thongprasom
- Oral Medicine Department, Faculty of Dentistry; Chulalongkorn University; Bangkok Thailand
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23
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Khudhur AS, Di Zenzo G, Carrozzo M. Oral lichenoid tissue reactions: diagnosis and classification. Expert Rev Mol Diagn 2014; 14:169-84. [DOI: 10.1586/14737159.2014.888953] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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24
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Bhattacharyya I, Kramer JM. Clinical pathologic conference case 5: Unusual severe glossitis. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 115:e46-9. [PMID: 23738346 DOI: 10.1016/j.oooo.2013.01.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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25
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Carlson MW, Garlick JA, Solomon LW. Chronic ulcerative stomatitis: evidence of autoimmune pathogenesis. ACTA ACUST UNITED AC 2011; 111:742-8. [DOI: 10.1016/j.tripleo.2010.12.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Revised: 12/02/2010] [Accepted: 12/29/2010] [Indexed: 11/29/2022]
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26
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Abstract
Oral lichen planus (OLP) is a chronic, immune-mediated condition commonly affecting middle-aged women. The cause of OLP remains obscure. Strict clinical and histologic criteria need to be met to arrive at a definite diagnosis, thereby ruling out other conditions that may mimic OLP clinically and/or histologically. Although OLP is considered a premalignant condition, the risk for neoplastic change seems low.
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Affiliation(s)
- Pallavi Parashar
- Department of Diagnostic and Biological Sciences, University of Colorado Denver School of Dental Medicine, Aurora, CO 80045, USA.
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27
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Solomon LW, Stark PC, Winter L, Kumar V, Sinha S. ELISA test for p63 antibodies in chronic ulcerative stomatitis. Oral Dis 2010; 16:151-5. [DOI: 10.1111/j.1601-0825.2009.01606.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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28
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Deniz E, Ozden MG, Cöloğlu AS, Sençift K, Aghaloo T. Large ulceration of the palate. J Oral Maxillofac Surg 2008; 66:1659-63. [PMID: 18634955 DOI: 10.1016/j.joms.2007.08.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Accepted: 08/30/2007] [Indexed: 11/19/2022]
Affiliation(s)
- Ediz Deniz
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Yeditepe University, Istanbul, Turkey.
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