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Kashyap B, Hyvärinen E, Laitinen I, Kullaa AM. Salivary metabolomics in patients with oral lichen planus: a preliminary study based on NMR spectroscopy. Clin Oral Investig 2024; 28:103. [PMID: 38236502 PMCID: PMC10796579 DOI: 10.1007/s00784-023-05389-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/12/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVES The present preliminary study aimed to investigate the salivary metabolic profile in patients with asymptomatic oral lichen planus (OLP) using nuclear magnetic resonance (NMR) spectroscopy. MATERIAL AND METHODS Stimulated whole mouth saliva (SWMS) samples were collected from 15 reticular OLP female patients and 15 from age- and sex-matched controls (HCs). A total of 23 metabolites were identified and quantified. Mann-Whitney's U test was used to compare the determined concentration salivary metabolite concentrations between OLP patients and the healthy controls. RESULTS The concentration of acetate, methylamine, and pyruvate was elevated, whereas the concentration of tyrosine was decreased in the saliva of OLP patients compared with HCs. To identify a combination of metabolites, multivariate discrimination function analysis (DFA) was conducted. DFA analysis have shown that the most powerful discrimination between the groups was achieved when methylamine and tyrosine were considered as combined biomarkers. CONCLUSIONS Salivary tyrosine was of particular interest and a promising finding for the screening of OLP and its progression. Further longitudinal studies are required to establish it as a reliable salivary biomarker in OLP. CLINICAL RELEVANCE The salivary metabolic profiling can describe the pathologic characteristics of OLP on non-invasive saliva samples and NMR analysis. Salivary metabolites provide details to considered early detectors and to impact oral health of OLP patients.
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Affiliation(s)
- Bina Kashyap
- Department of Oral Diagnostic Sciences, Faculty of Health Sciences, Institute of Dentistry, University of Eastern Finland, Kuopio Campus, PO Box 1627, 70211, Kuopio, Finland
| | - Eelis Hyvärinen
- Department of Oral Diagnostic Sciences, Faculty of Health Sciences, Institute of Dentistry, University of Eastern Finland, Kuopio Campus, PO Box 1627, 70211, Kuopio, Finland
| | | | - Arja M Kullaa
- Department of Oral Diagnostic Sciences, Faculty of Health Sciences, Institute of Dentistry, University of Eastern Finland, Kuopio Campus, PO Box 1627, 70211, Kuopio, Finland.
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2
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Unnikrishnan SP, Rampersaud E, Mcgee A, Cruickshank ME, Abu-Eid R, Hijazi K. Disease severity scoring systems in mucosal lichen planus: A systematic review. Oral Dis 2023; 29:3136-3151. [PMID: 36404123 DOI: 10.1111/odi.14447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/03/2022] [Accepted: 11/14/2022] [Indexed: 11/22/2022]
Abstract
Several scoring systems have been developed to evaluate disease severity in mucosal lichen planus, but only a few have been validated to ensure reproducible and accurate assessment of disease severity. The current systematic review was undertaken to identify clinical severity scoring systems in mucosal lichen planus that have undergone validity or reliability testing and to describe their operating characteristics. We performed a bibliographic search in five databases from their inception to October 2022 for severity scoring systems in mucosal lichen planus that have undergone validity or reliability tests. Quality assessment was conducted using the Joanna Briggs Institute Critical Appraisal tools. We have included 118 studies and identified 11 clinical severity scoring systems for oral lichen planus that have undergone validity or reliability testing. Of these, the most reported were the Thongprasom score, the Oral Disease Severity Score (ODSS) and the REU (Reticular/hyperkeratotic, Erosive/erythematous, Ulcerative) scoring systems. We did not identify clinical scoring systems for extraoral mucosal lichen planus that have undergone validity or reliability testing. The ODSS and REU scoring systems have undergone the highest number of validation attempts and reliability assessments for oral lichen planus respectively. However, we have identified numerous factors that have hampered the universal adoption of a standardised scoring system. There is a need for the development and validation of scoring systems for extraoral mucosal lichen planus.
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Affiliation(s)
- Sreedevi P Unnikrishnan
- Institute of Dentistry, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Edward Rampersaud
- Institute of Dentistry, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Alice Mcgee
- Aberdeen Centre for Women's Health Research, Aberdeen Maternity Hospital, Aberdeen, UK
| | - Maggie E Cruickshank
- Aberdeen Centre for Women's Health Research, Aberdeen Maternity Hospital, Aberdeen, UK
| | - Rasha Abu-Eid
- Institute of Dentistry, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Karolin Hijazi
- Institute of Dentistry, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
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Hanna R, Dalvi S, Tomov G, Hopper C, Rebaudi F, Rebaudi AL, Bensadoun RJ. Emerging potential of phototherapy in management of symptomatic oral lichen planus: A systematic review of randomised controlled clinical trials. JOURNAL OF BIOPHOTONICS 2023:e202300046. [PMID: 37017292 DOI: 10.1002/jbio.202300046] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/01/2023] [Accepted: 04/02/2023] [Indexed: 06/19/2023]
Abstract
Phototherapy incorporating photobiomodulation therapy and antimicrobial photodynamic therapy has been utilised as antioxidants in symptomatic oral lichen planus (OLP) management; however, its role of intervention remains controversial. The aim of this systematic review of CRD42021227788 PROSPERO (an international prospective register of systematic reviews in health and social care) registration number was to oversee and determine phototherapy efficacy in patients with symptomatic OLP, identifying and bridging the literature gaps by proposing recommendations for future studies. A search strategy was developed in consistent with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Various electronic databases were exercised to search for randomised controlled clinical trials (RCTs). Several search engines were employed to analyse a total of 177 studies of which nine included. A wide range of utilised laser and light-emitted diode wavelengths between 630 and 808 nm and irradiance ranged between 10 and 13 mW/cm2 were noted. 67% of studies reported a high risk of bias and a high heterogeneity obtained from numerical data for quantitative analysis, therefore meta-analysis was impossible to conduct. Despite inconsistency and diversity in phototherapy parameters, treatment protocols, photosensitiser (type, concentration and method of application) and outcome assessment tools, the majority of the studies showed positive results compared with standard care treatments. Hence, a necessity to perform well-designed RCTs with robust methodology is warranted, after acknowledging the current drawbacks and addressing the suggested recommendations highlighted in our review. Moreover, advanced knowledge in understanding further phototherapy-antioxidants molecular mechanistic in symptomatic OLP is required.
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Affiliation(s)
- Reem Hanna
- Department of Surgical Sciences and Integrated Diagnostics, Laser Therapy Centre, University of Genoa, Genoa, Italy
- Department of Restorative and Dental Sciences, UCL-Eastman Dental Institute, Faculty of Medical Sciences, Rockefeller Building, London, UK
| | - Snehal Dalvi
- Department of Periodontology, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, India
| | - Georgi Tomov
- Department of Periodontology, Faculty of Dental Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Colin Hopper
- Department of Maxillofacial Surgery, Diagnostics, Medical and Surgical Sciences, UCL-Eastman Dental Institute, Faculty of Medical Sciences, Rockefeller Building, London, UK
| | - Federico Rebaudi
- Department of Expiremental Medicine (DIMES), University of Genoa, Genoa, Italy
| | - Alberto Luigi Rebaudi
- Department of Surgery and Implants, School of Dentistry, Universitat International de Catalunya (UIC), Barcelona, Spain
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Seizer L, Schubert C. On the Role of Psychoneuroimmunology in Oral Medicine. Int Dent J 2022; 72:765-772. [DOI: 10.1016/j.identj.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/24/2022] [Accepted: 07/02/2022] [Indexed: 11/05/2022] Open
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Bacci C, Cerrato A, Frigo AC, Cocco M, Zanette G. Bioelectrical Impedance Analysis of Oral Cavity Mucosa in Patients with Lichen Planus and Healthy Controls. Dent J (Basel) 2022; 10:dj10070137. [PMID: 35877411 PMCID: PMC9319933 DOI: 10.3390/dj10070137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/04/2022] [Accepted: 07/14/2022] [Indexed: 01/27/2023] Open
Abstract
Objectives: Oral lichen planus (OLP) is an inflammatory disease. Bioelectrical impedance analysis (BIA) is a method for assessing tissue composition. Based on a combination of reactance and resistance data, a phase angle is calculated that may range from 90° to 0°, and that correlates with body cell mass. There is evidence to suggest that neoplastic tissue has a lower phase angle than normal tissue. The aim of the present experimental study was to establish whether OLP patients have a different tissue phase angle from healthy controls. Materials and Methods: Bioelectrical impedance measurements were obtained for the buccal mucosa, tongue, hard palate and upper anterior gums using an ad hoc device in a sample of 57 consecutive patients with OLP and 60 healthy controls, and their phase angles were calculated. Results: The mean resistance, reactance, and phase angle of the hard palate and gums were higher in the OLP group than in the controls, and the differences were statically significant. The resistance and reactance recorded for the adherent gingiva and hard palate were always higher in the OLP group (p = 0.044; p = 0.020; p = 0.054), and so was the phase angle for the adherent gingiva. No statistically significant differences emerged for the other areas of the oral cavity (p < 0.05). Conclusion: These findings confirm differences between the bioelectrical impedance of OLP lesions and that of healthy oral tissues. Clinical relevance: Bioelectrical impedance analysis could be useful in the diagnosis of OLP.
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Affiliation(s)
- Christian Bacci
- Oral Medicine and Pathology Unit, Clinical Dentistry Section, Department of Neurosciences, University of Padova, 35128 Padova, Italy; (A.C.); (M.C.)
- Correspondence:
| | - Alessia Cerrato
- Oral Medicine and Pathology Unit, Clinical Dentistry Section, Department of Neurosciences, University of Padova, 35128 Padova, Italy; (A.C.); (M.C.)
| | - Anna Chiara Frigo
- Departments of Cardiac, Thoracic, and Vascular Sciences, and Radiology, University of Padova, 35128 Padova, Italy;
| | - Matteo Cocco
- Oral Medicine and Pathology Unit, Clinical Dentistry Section, Department of Neurosciences, University of Padova, 35128 Padova, Italy; (A.C.); (M.C.)
| | - Gastone Zanette
- Dental Anesthesia, Clinical Dentistry Section, Department of Neurosciences, University of Padova, 35128 Padova, Italy;
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Demystifying Esophageal Lichen Planus: A Comprehensive Review of a Rare Disease You Will See in Practice. Am J Gastroenterol 2022; 117:70-77. [PMID: 34591036 DOI: 10.14309/ajg.0000000000001485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 08/03/2021] [Indexed: 12/11/2022]
Abstract
Lichen planus (LP) is a chronic inflammatory disorder that often affects the skin, hair, nails, and mucus membranes. Although esophageal involvement has traditionally been felt to be rare, recent reports suggest that it is often unrecognized or misdiagnosed. The diagnoses of esophageal lichen planus can be challenging and is suspected based on patients' endoscopic and histologic findings and in the context of their clinical history and physical examination. Physicians must have an index of suspicion, particularly in older white women and in those patients with an atypical esophagitis or stricturing disease, which do not respond to traditional treatment. Currently, there are limited data on esophageal lichen planus patients, and no formal management guidelines for this disease, which all gastroenterologists will see in practice. This article reviews the etiology and histopathology of LP and provides a comprehensive discussion of the clinical features, diagnosis, and management of esophageal disease from the gastroenterologist's perspective. Finally, we address the esophageal complications of LP.
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Kalaskar AR, Bhowate RR, Kalaskar RR, Walde SR, Ramteke RD, Banode PP. Efficacy of Herbal Interventions in Oral Lichen Planus: A Systematic Review. Contemp Clin Dent 2020; 11:311-319. [PMID: 33850395 PMCID: PMC8035840 DOI: 10.4103/ccd.ccd_320_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/24/2020] [Accepted: 09/23/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction: Oral lichen planus (OLP) is a chronic autoimmune condition requiring prompt treatment to alleviate the signs and symptoms. There is weak evidence emphasizing the efficacy of any one therapy. Steroids, of all the therapies, have proved to be effective and hence considered as the standard care for OLP. However, the complications associated with it further worsen the patient's condition. Alternative safe approaches such as herbal interventions (HIs) have been tried in OLP. Their efficacies could only be evaluated from properly designed research protocols such as randomized controlled trials (RCTs). The present systematic review aims to assess the efficacy of HIs compared to steroids in RCTs involving OLP. Materials and Methods: An extensive search for HIs in OLP was conducted in PubMed, MEDLINE, Cochrane Central Register of Controlled Trials, Scopus, and gray literature. Eight studies fulfilled the eligibility criteria. Results: In all the studies, clinical severity was significantly reduced in within-group comparisons, whereas between-group comparisons showed nonsignificant results, except for total glucosides of paeony capsules. Conclusion: Efficacy of herbal therapy in OLP should be weighed against the high bias in the studies.
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Affiliation(s)
- Ashita R Kalaskar
- Department of Oral Medicine and Radiology, Government Dental College and Hospital, Nagpur, Maharashtra, India
| | - Rahul R Bhowate
- Department of Oral Medicine and Radiology, Sharad Pawar Dental College and Hospital, DMIMS (DU), Sawangi (Meghe), Wardha, Maharashtra, India
| | - Ritesh R Kalaskar
- Department of Pedodontics and Preventive Dentistry, Government Dental College and Hospital, Nagpur, Maharashtra, India
| | - Sheelpriya R Walde
- Department of Quality Assurance, Gurunanak College of Pharmacy, Nagpur, Maharashtra, India
| | - Rachana D Ramteke
- Department of Kaumar Hritya, Shri Ayurvedic College and Hospital, Nagpur, Maharashtra, India
| | - Priyanka P Banode
- Department of Periodontology, Sharad Pawar Dental College, DMIMS DU, Sawangi (Meghe), Wardha, Maharashtra, India
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Yan YR, Hua F, He MJ, Lei T, Tan YQ, Zhou G. Heterogeneity of Outcome Measures Used in Randomized Controlled Trials for the Treatment of Oral Lichen Planus: A Methodological Study. J Evid Based Dent Pract 2020; 20:101468. [DOI: 10.1016/j.jebdp.2020.101468] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/02/2020] [Accepted: 06/09/2020] [Indexed: 02/06/2023]
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9
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Hasan S, Ahmed S, Kiran R, Panigrahi R, Thachil JM, Saeed S. Oral lichen planus and associated comorbidities: An approach to holistic health. J Family Med Prim Care 2019; 8:3504-3517. [PMID: 31803644 PMCID: PMC6881968 DOI: 10.4103/jfmpc.jfmpc_749_19] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 09/08/2019] [Accepted: 09/23/2019] [Indexed: 02/06/2023] Open
Abstract
Lichen planus (LP) is a chronic inflammatory disorder with involvement of skin, oral and genital mucosa, scalp, and nail appendages. Oral lichen planus (OLP) lesions demonstrate a number of morphologic presentations, persist for a long time with rare self-resolution, and undergo malignant changes. OLP has been associated with numerous systemic connotations such as metabolic syndrome, diabetes mellitus, hypertension, thyroid diseases, psychosomatic ailments, chronic liver disease, gastrointestinal diseases, and genetic susceptibility to cancer. The oral health physician should be aware of these systemic associations and should work in close connect with the primary healthcare physicians to rule out the predisposing factors for the associated comorbidities. This article aims to highlight the various systemic associations of OLP and warrants the screening of these ailments in OLP for prevention and effective management.
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Affiliation(s)
- Shamimul Hasan
- Department of Oral Medicine and Radiology, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India
| | - Sameer Ahmed
- Department of Periodontology, Darshan Dental College and Hospitals Udaipur, Rajasthan, India
| | - Ravi Kiran
- Department of Periodontology, Darshan Dental College and Hospitals Udaipur, Rajasthan, India
| | - Rajat Panigrahi
- Department of Oral Medicine and Radiology, Institute of Dental Sciences, SOA University, Bhubaneswar, Odisha, India
| | | | - Shazina Saeed
- Amity Institute of Public Health, Amity University, Noida, Uttar Pradesh, India
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Abstract
Mucocutaneous diseases affecting the oral cavity are predominantly immune mediated or inflammatory. Three of the most common and clinically significant conditions are reviewed in this article: lichen planus, pemphigus vulgaris, and mucous membrane pemphigoid. Because oral manifestations may be the first or only manifestation of mucocutaneous diseases, oral health professionals play a critical role in the early diagnosis and multidisciplinary management of these conditions.
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11
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Izzetti R, Vitali S, Oranges T, Dini V, Romanelli M, Caramella D, Gabriele M. Intraoral Ultra-High Frequency Ultrasound study of oral lichen planus: A pictorial review. Skin Res Technol 2019; 26:200-204. [PMID: 31549746 DOI: 10.1111/srt.12777] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 09/02/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ultra-High Frequency Ultrasound (UHFUS) is a recently introduced diagnostic technique involving the use of higher frequencies compared to conventional ultrasound. Among the several fields of application, intraoral usage of UHFUS appears still limited. We report the intraoral evaluation of Oral Lichen Planus (OLP) by means of UHFUS and describe typical UHFUS aspect of different forms of presentation of OLP. MATERIALS AND METHODS Patients with clinical and histological diagnosis of OLP were enrolled in the study. OLP lesions were evaluated by means of intraoral UHFUS performed at 70 MHz, using B-mode and C-mode, in order to characterize the echostructure of each form of presentation. RESULTS Fifty patients in total were enrolled, and UHFUS features were described for different OLP forms. All the lesions showed a thick, hypoechoic superficial layer in the mucosal stratum, suggesting that such UHFUS alteration can be pathognomonic of OLP. CONCLUSION Ultra-High Frequency Ultrasound was able to differentiate superficial alterations of the oral mucosa, giving insight on possible applications of UHFUS in the study of OLP beyond clinical and histological investigations. Due to a limited study sample, we cannot draw firm conclusions. However, it is reasonable to think that UHFUS evaluation of OLP may provide useful information to the clinician.
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Affiliation(s)
- Rossana Izzetti
- Department of Translational Research and of New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Saverio Vitali
- Diagnostic and Interventional Radiology, University Hospital of Pisa, Pisa, Italy
| | - Teresa Oranges
- Department of Translational Research and of New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Valentina Dini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marco Romanelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Davide Caramella
- Diagnostic and Interventional Radiology, University Hospital of Pisa, Pisa, Italy
| | - Mario Gabriele
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University Hospital of Pisa, Pisa, Italy
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Abstract
Lichen planus (LP) is a potentially malignant disorder with an immune-mediated etiopathogenesis. The condition frequently affects the skin, oral mucosa, skin appendages, and other mucous membranes. Oral lesions usually precede the onset of skin lesions and in majority of cases may only be presenting symptom. Isolated LP of the lip is rarely encountered in the clinical practice and is usually seen along with skin/other mucous membrane involvement. The clinical appearance poses diagnostic dilemmas and is often misinterpreted. This case report aims to highlight an interesting case of LP of the lower lip in a 50-year-old male patient. The patient presented with a diffuse erosive lesion on the lower lip bordered by white radiating striae on its inner aspect. Histopathological and immunofluorescent studies confirmed LP of the lip. Topical corticosteroids and Vaseline lip therapy were prescribed to the patient. There was considerable healing in the lip lesion during the follow-up period. However, recurrence was noted in the left buccal mucosa.
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Affiliation(s)
- Shamimul Hasan
- Department of Oral Medicine and Radiology, Faculty of Dentistry, Jamia Millia Islamia University, New Delhi, India
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Topical pimecrolimus versus betamethasone for oral lichen planus: a randomized clinical trial. Clin Oral Investig 2018; 23:947-956. [PMID: 29909565 DOI: 10.1007/s00784-018-2519-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 06/05/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Oral lichen plans (OLP) is a potentially malignant inflammatory mucocutaneous disease. CD133 is an investigated surface marker for cancer stem-like cells (CSCs) that may be involved in tumor initiation in head and neck carcinomas. We compared short-term clinical effectiveness of topical pimecrolimus as selective inflammatory cytokine release inhibitor with betamethasone cream for erosive/atrophic OLP and investigated the influence of this therapy on CD133 expression. MATERIAL AND METHODS Thirty patients were randomly assigned into two equal groups to receive topical pimecrolimus (group I) or betamethasone (group II) four times daily for 4 weeks. A marker lesion in each patient were assessed at baseline using clinical score (CS) and visual analog scale (VAS) then at 1, 2, and 4 weeks and after 4 weeks of treatment-free period. CD133 expression was detected in pre- and post-treatment immunostained sections. RESULTS Both drugs showed a reduction in CS, VAS, and CD133 expressions after treatment termination (p < 0.001). Pimecrolimus-treated lesions showed significant higher 1st week reduction in severity (33.1% (22.2)), pain score (57.53% (14.27)), less recurrence in follow-up period and less CD133 expression by the end of the 1st 4 weeks compared with betamethasone. CONCLUSION Pimecrolimus showed earlier clinical response and less recurrence rate compared with standard topical corticosteroid in symptomatic OLP lesions, and both treatment reduced CD133-positive CSC population. CLINICAL RELEVANCE The study proved the benefits of topical pimecrolimus in early management of painful lesions of OLP and its ability to inhibit CSCs, suggesting a possible role in reducing risk of malignant transformation.
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Gopal P, Gibson JA, Lisovsky M, Nalbantoglu ILK. Unique causes of esophageal inflammation: a histopathologic perspective. Ann N Y Acad Sci 2018; 1434:219-226. [PMID: 29766506 DOI: 10.1111/nyas.13732] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 03/16/2018] [Accepted: 03/20/2018] [Indexed: 12/18/2022]
Abstract
Gastroenterologists frequently perform endoscopic esophageal mucosal biopsies for pathologic diagnosis in patients experiencing symptoms of esophagitis. The more common causes of esophagitis diagnosed on esophageal mucosal biopsy include reflux esophagitis, eosinophilic esophagitis, and infectious esophagitis caused by Candida albicans, herpes simplex virus, and/or cytomegalovirus. However, there are several causes of esophagitis seen less frequently by pathologists that are very important to recognize. We discuss unique types of esophageal inflammation, including acute bacterial esophagitis, esophageal manifestations of dermatologic diseases, medication-induced esophageal injury, and sloughing esophagitis; and we review their clinical and histopathologic features.
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Affiliation(s)
- Purva Gopal
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Joanna A Gibson
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
| | - Mikhail Lisovsky
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - ILKe Nalbantoglu
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
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Sonthalia S, Varma S, Jha AK, Jakhar D, Kaliyadan F. Case Report: Dermoscopic features of oral lichen planus - the evolution of mucoscopy. F1000Res 2018; 7:284. [PMID: 29623194 PMCID: PMC5861519 DOI: 10.12688/f1000research.14134.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2018] [Indexed: 01/16/2023] Open
Abstract
Dermoscopy, a non-invasive technique for cutaneous diagnosis is being increasingly studied in various disorders of the skin, nails and scalp. However, it has been under-utilized for the diagnosis and characterization of mucosal disorders. The dermoscopic characterization of cutaneous lichen planus and its variants has been well documented with Wickham’s striae constituting the hallmark of the condition. However, the dermoscopic features of oral lichen planus with hand-held or videodermoscopy remain to be elucidated. We present the case of a young adult man who presented with asymptomatic white lacy lesions over a bluish-black background over the tongue, patchy hyperpigmentation of the buccal mucosae and gingivae, and longitudinal melanonychia involving some nails. History of intake of any drugs preceding the lesions, smoking, chewing of betel nut and dental implants was negative. Family history was non-contributory. There were no cutaneous lesions suggestive of lichen planus. Mucoscopy (dermoscopy of the mucosa, oral in this case) and onychoscopy were done followed by biopsy from the tongue that confirmed the diagnosis of lichen planus. Oral mucoscopy of the tongue revealed a tri-colored pattern with structureless veil-like grey-white areas (modified Wickham’s striae), well-demarcated red glossy erosions, and violaceous-to-brown clods. Additionally, vascular pattern of dotted and linear to curved vessels along the borders of leukoplakia-like areas and erosions were observed. Onychoscopy confirmed lichen planus-associated melanonychia. Dermoscopy also proved useful in conveniently ruling out other disorders typified by mucosal and nail pigmentation such as Laugier Hunziker syndrome and drug-induced changes. Although direct oral microscopy has been used in defining features of oral lichen planus, to the best of our knowledge this case is the first report on mucoscopy or dermoscopy of oral lichen planus
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Affiliation(s)
- Sidharth Sonthalia
- Skinnocence: The Skin Clinic & Research Centre, C-2246, Sushant Lok-1, Block-C, Gurugram, 122009, India
| | - Sangeeta Varma
- Department of Dermatology, Kalyani Hospital & Twachapal Skin Clinic, Gurugram-122016, Haryana, India
| | - Abhijeet Kumar Jha
- Department of Dermatology & STD, Patna Medical College & Hospital (PMCH), Ashok Rajpath, Patna-400008, Bihar, India
| | - Deepak Jakhar
- Department of Dermatology & STD, Hindu Rao Hospital, Sabji Mandi, New Delhi, 110007, India
| | - Feroze Kaliyadan
- Department of Dermatology, College of Medicine, King Faisal University, Hofuf, Saudi Arabia
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Gobbo M, Rupel K, Zoi V, Perinetti G, Ottaviani G, Di Lenarda R, Bevilacqua L, Woo SB, Biasotto M. Scoring systems for Oral Lichen Planus used by differently experienced raters. Med Oral Patol Oral Cir Bucal 2017; 22:e562-e571. [PMID: 28809373 PMCID: PMC5694178 DOI: 10.4317/medoral.21833] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Indexed: 01/30/2023] Open
Abstract
Background Scoring systems have been widely used to evaluate the severity and activity of oral lichen planus (OLP). The aim of the present study was to compare two existing (one modified) scoring systems in the evaluation of OLP severity and correlation with pain. Three differently experienced raters were involved. Material and Methods Consecutive patients with OLP were assessed for pain using the Visual Analogue Scale and examined at 10 intraoral sites before starting (T0) and three weeks after (T1) steroid therapy (Clobetasol). Three differently experienced raters evaluated photographs using two scoring systems designated White-Erosive-Atrophic (WEA) modified from an older WEA system (WEA-MOD) and Reticular-erythematous-Ulcerative (REU) systems. WEA-MOD Kendall’s W and interclass correlation coefficient were calculated and correlation between REU/WEA-MOD and pain was calculated using Spearman coefficient. Results Most patients showed lesions on buccal mucosa (85-93,5%) and maxillary/mandibular gingivae (31,8-31,2%), predominantly reticular. At T0, Kendall-W coefficients of 0.89 and 0.74 were obtained for the REU and WEA respectively. At T1, Kendall-W coefficients of 0.83 and 0.58 were obtained for the REU and WEA respectively. Interclass correlation coefficient ranged from 0.87 to 0.90 for REU and from 0.58 to 0.87 for WEA. REU and WEA scores significantly decreased after therapy (p<0.000) as well as VAS (p<0.05). REU score showed correlation with VAS. Conclusions All the raters achieved comparable measures using REU whereas WEA and WEA-MOD seem less reproducible. REU seems to correlate to disease activity and pain. Key words:Oral lichen planus, scoring system, VAS, REU, WEA, rater.
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Affiliation(s)
- M Gobbo
- Division of oral medicine and pathology, Dental Science Department, Ospedale Maggiore, 34100, Trieste, Italy,
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Sayiner M, Golabi P, Farhat F, Younossi ZM. Dermatologic Manifestations of Chronic Hepatitis C Infection. Clin Liver Dis 2017; 21:555-564. [PMID: 28689593 DOI: 10.1016/j.cld.2017.03.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Chronic hepatitis C virus (HCV) infection is associated with various extrahepatic manifestations, including dermatologic involvement mostly caused by immune complexes. Mixed cryoglobulinemia has a strong relationship with HCV with 95% of these patients being infected with HCV. Lichen planus is a disease of the squamous epithelium and may affect any part of the skin, with 4% to 24% of patients with lichen planus reported to have chronic HCV infection. Porphyria cutanea tarda is the most common form of porphyria, and it is thought that HCV interferes with iron stores, which can promote porphyria cutanea tarda. Finally, necrolytic acral erythema is a rare, psoriasis-like disease closely associated with HCV.
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Affiliation(s)
- Mehmet Sayiner
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Inova Fairfax Hospital, Claude Moore Health Education and Research Building, 3rd Floor, 3300 Gallows Road, Falls Church, VA 22042, USA; Department of Medicine, Center for Liver Disease, Inova Fairfax Hospital, Claude Moore Health Education and Research Building, 3rd Floor, 3300 Gallows Road, Falls Church, VA 22042, USA
| | - Pegah Golabi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Inova Fairfax Hospital, Claude Moore Health Education and Research Building, 3rd Floor, 3300 Gallows Road, Falls Church, VA 22042, USA
| | - Freba Farhat
- Department of Medicine, Center for Liver Disease, Inova Fairfax Hospital, Claude Moore Health Education and Research Building, 3rd Floor, 3300 Gallows Road, Falls Church, VA 22042, USA
| | - Zobair M Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Inova Fairfax Hospital, Claude Moore Health Education and Research Building, 3rd Floor, 3300 Gallows Road, Falls Church, VA 22042, USA; Department of Medicine, Center for Liver Disease, Inova Fairfax Hospital, Claude Moore Health Education and Research Building, 3rd Floor, 3300 Gallows Road, Falls Church, VA 22042, USA.
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Abstract
Lichen planus is an inflammatory mucocutaneous disease that can affect the skin, hair, nails, and mucosal surfaces. Mucosal sites of involvement include oral, genital, ocular, otic, esophageal, and, less commonly, bladder, nasal, laryngeal, and anal surfaces. Oral lichen planus is a mucosal variant of lichen planus, which tends to affect women more often than men, with a typically more chronic course and potential for significant morbidity. Treatment can be challenging, and there is potentially a low risk of malignant transformation; however, therapeutic benefits can be obtained with various topical and systemic medications. Clinical monitoring is recommended to ensure symptomatic control. Increasing awareness and recognition of this entity have continued to fuel advances in therapy and in our understanding of the disease.
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Affiliation(s)
| | - Roy S Rogers
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ
| | - Alison J Bruce
- Department of Dermatology, Mayo Clinic, Jacksonville, FL.
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19
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Chamani G, Rad M, Zarei MR, Lotfi S, Sadeghi M, Ahmadi Z. Efficacy of tacrolimus and clobetasol in the treatment of oral lichen planus: a systematic review and meta-analysis. Int J Dermatol 2015. [DOI: 10.1111/ijd.12925] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Goli Chamani
- Orofacial Pain Clinic; Department of Oral Medicine; Dental School; Kerman Iran
| | - Maryam Rad
- Oral and Dental Diseases Research Center; Kerman University of Medical Sciences; Kerman Iran
| | - Mohammad Reza Zarei
- Orofacial Pain Clinic; Department of Oral Medicine; Dental School; Kerman Iran
| | - Sodabeh Lotfi
- Orofacial Pain Clinic; Department of Oral Medicine; Dental School; Kerman Iran
| | - Masoumeh Sadeghi
- Research Center for Modeling in Health; Kerman University of Medical Sciences; Kerman Iran
| | - Zahra Ahmadi
- Oral and Dental Diseases Research Center; Kerman University of Medical Sciences; Kerman Iran
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20
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Dillenburg CS, Martins MAT, Almeida LO, Meurer L, Squarize CH, Martins MD, Castilho RM. Epigenetic Modifications and Accumulation of DNA Double-Strand Breaks in Oral Lichen Planus Lesions Presenting Poor Response to Therapy. Medicine (Baltimore) 2015; 94:e997. [PMID: 26222871 PMCID: PMC4554108 DOI: 10.1097/md.0000000000000997] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Epigenetics refers to changes in cell characteristics that occur independently of modifications to the deoxyribonucleic acid (DNA) sequence. Alterations mediated by epigenetic mechanisms are important factors in cancer progression. Although an exciting prospect, the identification of early epigenetic markers associated with clinical outcome in premalignant and malignant disorders remains elusive. We examined alterations in chromatin acetylation in oral lichen planus (OLP) with distinct clinical behavior and compared the alterations to the levels of DNA double-strand breaks (DSBs). We analyzed 42 OLP patients, who had different responses to therapy, for acetyl-histone H3 at lys9 (H3K9ac), which is associated with enhanced transcription and nuclear decondensation, and the presence of DSBs, as determined by accumulation of phosphorylated γH2AX foci. Patients with high levels of H3K9ac acetylation failed to respond to therapy or experienced disease recurrence shortly after therapy. Similar to H3K9ac, patients who responded poorly to therapy had increased accumulation of DNA DSB, indicating genomic instability. These findings suggest that histone modifications occur in OLP, and H3K9ac and γH2AX histones may serve as epigenetic markers for OLP recurrence.
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Affiliation(s)
- Caroline S Dillenburg
- From the Department of Oral Pathology (CSD, MDM), School of Dentistry; Department of Oral Medicine (MATM), Hospital de Clínicas de Porto Alegre (HCPA/UFRGS); Department of Pathology (LM), School of Medicine, Hospital de Clínicas de Porto Alegre (HCPA/UFRGS), Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; and Laboratory of Epithelial Biology (CSD, MATM, LOA, CHS, MDM, RMC), Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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21
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Affiliation(s)
- T Yap
- Melbourne Dental School; The University of Melbourne; Victoria Australia
| | - M McCullough
- Melbourne Dental School; The University of Melbourne; Victoria Australia
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22
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Abstract
Oral lichen planus (OLP) is commonly found in middle-aged women. Although the cause is unknown, research points to several complex immunologic events and cells that are responsible for the inflammatory destruction and chronicity of these lesions. Biopsy for histologic diagnosis is recommended. The mainstay of treatment remains topical corticosteroids; however, newer therapies such as immunomodulating agents are available for recalcitrant lesions. In cases of lichenoid mucositis or reactions, treatment should be directed at identifying and removing the presumed cause. Given the apparent risk of squamous cell carcinoma in these patients, frequent follow-up and repeat biopsy are vital.
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Affiliation(s)
- Scott S De Rossi
- Department of Oral Health and Diagnostic Sciences, College of Dental Medicine, Georgia Regents University, 1120 15th Street, Augusta, GA 30912, USA; Department of Otolaryngology/Head & Neck Surgery, Medical College of Georgia, Georgia Regents University, 1120 15th Street, Augusta, GA 30912, USA; Department of Dermatology, Medical College of Georgia, Georgia Regents University, 1120 15th Street, Augusta, GA 30912, USA.
| | - Katharine Ciarrocca
- Department of Oral Rehabilitation, College of Dental Medicine, Georgia Regents University, 1120 15th Street, Augusta, GA 30912, USA
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23
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Abstract
Oral mucosal diseases encompass several common conditions that affect the general population. Some of these disorders present with signs and symptoms that are pathognomonic for the condition, whereas others present with similar features that can make clinical diagnosis difficult to achieve. It is important for physicians to have a clear understanding of these disorders to provide appropriate care to patients. This article reviews clinical aspects of common oral mucosal disorders, including candidiasis, herpes simplex viral infections, aphthous stomatitis, lichen planus, pemphigus vulgaris, and mucous membrane pemphigoid.
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Affiliation(s)
- Eric T Stoopler
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104, USA.
| | - Thomas P Sollecito
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104, USA
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24
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Abstract
Oral pathologic abnormality is common and can be potentially serious. There are many diseases of the mouth that medical personnel must be able to diagnose and initiate management. The most prevalent lesions can be categorized as infectious, inflammatory, and common benign and malignant lesions. This article discusses prevalence, cause, diagnosis, and management of lesions such as stomatitis, candidiasis, caries, oral cancers, and bony tori.
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Affiliation(s)
- Hugh Silk
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA, USA.
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25
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Dillenburg CS, Martins MAT, Munerato MC, Marques MM, Carrard VC, Sant'Ana Filho M, Castilho RM, Martins MD. Efficacy of laser phototherapy in comparison to topical clobetasol for the treatment of oral lichen planus: a randomized controlled trial. JOURNAL OF BIOMEDICAL OPTICS 2014; 19:068002. [PMID: 24887747 DOI: 10.1117/1.jbo.19.6.068002] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 04/30/2014] [Indexed: 06/03/2023]
Abstract
Oral lichen planus (OLP) is a relatively common chronic mucocutaneous inflammatory disease and a search for novel therapeutic options has been performed. We sought to compare the efficacy of laser phototherapy (LPT) to topical clobetasol propionate 0.05% for the treatment of atrophic and erosive OLP. Forty-two patients with atrophic/erosive OLP were randomly allocated to two groups: clobetasol group (n=21): application of topical clobetasol propionate gel (0.05%) three times a day; LPT group (n=21): application of laser irradiation using InGaAlP diode laser three times a week. Evaluations were performed once a week during treatment (Days 7, 14, 21, and 30) and in four weeks (Day 60) and eight weeks (Day 90) after treatment. At the end of treatment (Day 30), significant reductions in all variables were found in both groups. The LPT group had a higher percentage of complete lesion resolution. At follow-up periods (Days 60 and 90), the LPT group maintained the clinical pattern seen at Day 30, with no recurrence of the lesions, whereas the clobetasol group exhibited worsening for all variables analyzed. These findings suggest that the LPT proved more effective than topical clobetasol 0.05% for the treatment of OLP.
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Affiliation(s)
- Caroline Siviero Dillenburg
- Universidade Federal do Rio Grande do Sul, School of Dentistry, Department of Oral Pathology, Porto Alegre, Rio Grande do Sul 90035-003, Brazil
| | - Marco Antonio Trevizani Martins
- Universidade Federal do Rio Grande do Sul, School of Dentistry, Department of Oral Medicine, Porto Alegre, Rio Grande do Sul 90035-003, Brazil
| | - Maria Cristina Munerato
- Universidade Federal do Rio Grande do Sul, School of Dentistry, Department of Oral Medicine, Porto Alegre, Rio Grande do Sul 90035-003, Brazil
| | - Márcia Martins Marques
- University of São Paulo, School of Dentistry, Department of Dentistry, São Paulo, São Paulo 05508-000, Brazil
| | - Vinícius Coelho Carrard
- Universidade Federal do Rio Grande do Sul, School of Dentistry, Department of Oral Pathology, Porto Alegre, Rio Grande do Sul 90035-003, Brazil
| | - Manoel Sant'Ana Filho
- Universidade Federal do Rio Grande do Sul, School of Dentistry, Department of Oral Pathology, Porto Alegre, Rio Grande do Sul 90035-003, Brazil
| | - Rogério Moraes Castilho
- University of Michigan, School of Dentistry, Laboratory of Epithelial Biology, Department of Periodontics and Oral Medicine, Ann Arbor, Michigan 48109-1078
| | - Manoela Domingues Martins
- Universidade Federal do Rio Grande do Sul, School of Dentistry, Department of Oral Pathology, Porto Alegre, Rio Grande do Sul 90035-003, Brazil
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26
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Bariş E, Sengüven B, Tüzüner T, Gültekin S. Oral Lichenoid Lesions Related to Drugs: Review of Clinicopathological Features and Differential Diagnosis. EUR J INFLAMM 2014. [DOI: 10.1177/1721727x1401200201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Lichenoid drug reaction is termed as a condition of the oral cavity having an identifiable etiology, which is clinically and histologically similar to oral lichen planus. A number of drugs have been described as a causative factor of those reactive lesions. The aim of this study is to conduct a systematic review on the role of causative drugs in oral lichenoid lesions (OLLD) and the clinicopathological features of this entity which still has uncertainty in diagnosis. Bibliographic searches were carried out to identify articles published in English on PubMed® Online electronic databases from 1993 to 2013. Available clinical, histological and treatment methods were recorded. A total of 25 articles fulfilled the inclusion criteria with 37 patients. OLLD were detected frequently in patients with a history of zidovudine and imatinib mesylate medication. OLLD occurred significantly in subjects over the age of 30 (p<0.01), mostly on buccal mucosa (42.37%). The most preferable treatment is withdrawal of the drugs and administering a topical steroid regimen. Thirty OLLD cases were confirmed by biopsies which were characterized by diffuse inflammatory infiltrate through the deep side of the lamina propria. Medical history and histological features are the two basic criteria for the differential diagnosis of OLLD.
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Affiliation(s)
- E. Bariş
- Gazi University, Faculty of Dentistry, Department of Oral Pathology, Ankara, Turkey
| | - B. Sengüven
- Gazi University, Faculty of Dentistry, Department of Oral Pathology, Ankara, Turkey
| | - T. Tüzüner
- Karadeniz Technical University, Faculty of Dentistry, Department of Pedodontics, Trabzon, Turkey
| | - S.E. Gültekin
- Gazi University, Faculty of Dentistry, Department of Oral Pathology, Ankara, Turkey
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27
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Histologic lichenoid features in oral dysplasia and squamous cell carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 117:511-20. [DOI: 10.1016/j.oooo.2013.12.413] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 12/28/2013] [Accepted: 12/31/2013] [Indexed: 11/23/2022]
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28
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Guarneri F, Guarneri C, Marini H. Oral lichen planus and neurogenic inflammation: new observations and therapeutic implications from four clinical cases. Dermatol Ther 2014; 27:206-10. [PMID: 24548522 DOI: 10.1111/dth.12118] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Oral lichen planus (OLP) is a usually chronic and relapsing mucocutaneous disease with unknown etiology. Immunosuppressive treatment is sometimes unsatisfactory. We describe four cases of reticular OLP localized on the internal side of cheek, in the territory innervated by sensory free endings of the buccinator nerve, poorly responding to immunosuppressive treatment (topical/systemic corticosteroids, topical cyclosporin). Addition of prazepam 10 mg/day to standard therapy achieved significant improvement and clinical healing in 30-40 days. Because of the complex interplay between the nervous and immune systems, neuroinflammation, acting through conventional axon reflex and/or indirect reflex mechanism involving localized efferent vasodilatory parasympathetic fibers, could have an important pathogenic role in OLP. Such hypothesis could explain, at least partly, the spreading of lesions in OLP primarily triggered (and possibly sustained) by infections, irritants, or autoimmunity. Moreover, neuroinflammation could have a relevant role in OLP related to psychosomatic diseases, where the nervous component is the primary trigger and the main pathogen responsible for the lesions observed. Benzodiazepines modulate neuroinflammation through central, and, possibly, peripheral action. In OLP patients with mild/subclinical psychological conditions, low doses may effectively modulate neuroinflammatory pathways that are not always completely inhibited by immunosuppressive treatment and can contribute to the persistence of inflammation.
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Affiliation(s)
- Fabrizio Guarneri
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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29
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The malignant transformation of oral lichen planus and oral lichenoid lesions. J Am Dent Assoc 2014; 145:45-56. [DOI: 10.14219/jada.2013.10] [Citation(s) in RCA: 209] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Kolios AGA, Marques Maggio E, Gubler C, Cozzio A, Dummer R, French LE, Navarini AA. Oral, esophageal and cutaneous lichen ruber planus controlled with alitretinoin: case report and review of the literature. Dermatology 2013; 226:302-10. [PMID: 23948733 DOI: 10.1159/000349980] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 02/07/2013] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Therapy-resistant lichen planus (LP) can be a challenging condition for dermatologists. There are some case reports about successful treatments with alitretinoin of cutaneous and oral, but not of esophageal LP. OBJECTIVE We present the unique case of a patient with cutaneous, oral and esophageal LP which was refractory to classical treatment options (topical clobetasol propionate and pimecrolimus, intramuscular triamcinolone acetonide); because of systemic side effects the patient did not tolerate systemic acitretin dosed up to 25 mg daily. METHODS Oral alitretinoin was used at a dose of 30 mg daily. RESULTS Both oral and skin changes as well as dysphagia completely resolved within 4 weeks without any severe side effects and the drug was used for 6 months. No papules, intraoral striae or dysphagia recurred during the 6 months of treatment. After 4 months the patient relapsed with mucosal patches so that a second cycle was initiated for 6 months where oral LP lesions resolved after 4 weeks also (with sporadic mild headache). CONCLUSION Further studies are needed to better understand the impact of alitretinoin in LP. Our observation suggests alitretinoin as a new, well-tolerated treatment option for esophageal LP after failed response to conventional treatments.
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Affiliation(s)
- Antonios G A Kolios
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
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31
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Malik U, Gupta S, Malik SD, Vashishth S, Zaheeruddin, Raju MS. Treatment of symptomatic oral lichen planus (OLP) with 0.1% tacrolimus powder in Oraguard-B - A pilot prospective study. Saudi Dent J 2012; 24:143-8. [PMID: 23960543 DOI: 10.1016/j.sdentj.2012.05.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 02/05/2012] [Accepted: 05/14/2012] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES The purpose of this study was to investigate the efficacy and safety of 0.1% tacrolimus powder in Oraguard-B for the treatment of patients with symptomatic oral lichen planus (OLP). METHODS This was a nonrandomized, nonblinded study conducted in the outpatient department. The 20 patients with symptomatic OLP oral lichen planus who were asked to participate in the study were provided with 20-g containers of the study medication. Patients were asked to use the medication over the symptomatic areas three times a day until resolution of the lesion. Patients were recalled to assess the drug response every 15 days. RESULTS The duration of treatment ranged from 30 to 183 days, with a mean of 81.8 ± 44.4 days; all 20 patients reported a favourable response to the topical tacrolimus therapy. Eleven patients had complete resolution of their lesions. In 16 of 20 patients, there was marked resolution in symptoms as recorded by visual analogue scale. Out of 10 patients followed up for a period of 3 months, 5 had recurrence of their lesions but with less intensity, and the patients were symptomless. No serious side effects were associated with the study medication. CONCLUSION Topical tacrolimus 0.1% in Oraguard-B was effective and safe in treating patients with OLP. However, there is still a need to undertake more detailed and objective clinical studies to determine the exact benefit of tacrolimus compared with conventional therapies and examine the influence of different dose regimes and formulations and assess the incidence of recurrence.
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Affiliation(s)
- Upender Malik
- Department of Oral Medicine, Diagnosis & Radiology, Shree Bankey Bihari Dental College & Hospital, 0.5 Km Ahead of Masuri Canal, Ghaziabad 201302, Uttar-Pradesh, India
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Park HK, Hurwitz S, Woo SB. Oral lichen planus: REU scoring system correlates with pain. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114:75-82. [PMID: 22727095 DOI: 10.1016/j.oooo.2012.02.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 02/13/2012] [Accepted: 02/24/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The objectives of this study were to correlate a semiquantitative scoring system for oral lichen planus (OLP) with pain before versus after treatment and to analyze sites of involvement and candidal status of patients in a retrospective study. STUDY DESIGN Reticulation/keratosis, erythema, and ulceration (REU) scores and numerical rating scale (NRS) for pain were used. Correlation was tested using Spearman rank correlation, and the change in REU and NRS scores using the paired t test. RESULTS One hundred fifteen patients were evaluable with 55 follow-up visits. Pain showed positive correlation with the total weighted score (r = .40), erythema (r = .35), ulceration (r = .31), and reticulation scores (r = .29), all at P < .005. There was improvement in REU and NRS scores before versus after treatment (P < .0001). The internal consistency reliability analysis yielded good reliability with Cronbach coefficient alpha of 0.70. The ventral tongue, floor of mouth, and soft palate were never the only sites affected. Candidal carriage was present in 24% of cases but candidiasis developed in only 10% of carriers. CONCLUSIONS The REU system is easy to use, correlates with an NRS for pain, and reliably reflects improvement attributable to treatment. Ventral tongue, floor of mouth, and soft palate were sites of OLP only if other sites were involved and candidiasis did not always develop in patients who were carriers.
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Affiliation(s)
- Hee-Kyung Park
- Department of Oral Medicine and Oral Diagnosis, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea.
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34
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Lo Russo L, Fedele S, Guiglia R, Ciavarella D, Lo Muzio L, Gallo P, Di Liberto C, Campisi G. Diagnostic Pathways and Clinical Significance of Desquamative Gingivitis. J Periodontol 2008; 79:4-24. [PMID: 18166088 DOI: 10.1902/jop.2008.070231] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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35
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Berk DR, Mallory SB, Keeffe EB, Ahmed A. Dermatologic disorders associated with chronic hepatitis C: effect of interferon therapy. Clin Gastroenterol Hepatol 2007; 5:142-51. [PMID: 16919505 DOI: 10.1016/j.cgh.2006.06.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Chronic hepatitis C virus infection (HCV) is associated with extrahepatic manifestations, including such dermatologic conditions as mixed cryoglobulinemia, porphyria cutanea tarda, and lichen planus. Patients with chronic HCV and extrahepatic manifestations are often excluded from clinical trials evaluating interferon (IFN) therapy due to concerns about poor response, adverse events, and toxicity. Thus, data regarding the efficacy of IFN not only on the underlying chronic HCV, but also on extrahepatic manifestations, are limited in these patients. Case reports suggest that the response of dermatologic extrahepatic manifestations to IFN in patients with chronic HCV is highly variable. This review summarizes available data on dermatologic conditions associated with chronic HCV and their response to IFN therapy.
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Affiliation(s)
- David R Berk
- Division of Dermatology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
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36
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Al-Hashimi I, Schifter M, Lockhart PB, Wray D, Brennan M, Migliorati CA, Axéll T, Bruce AJ, Carpenter W, Eisenberg E, Epstein JB, Holmstrup P, Jontell M, Lozada-Nur F, Nair R, Silverman B, Thongprasom K, Thornhill M, Warnakulasuriya S, van der Waal I. Oral lichen planus and oral lichenoid lesions: diagnostic and therapeutic considerations. ACTA ACUST UNITED AC 2007; 103 Suppl:S25.e1-12. [PMID: 17261375 DOI: 10.1016/j.tripleo.2006.11.001] [Citation(s) in RCA: 213] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2006] [Accepted: 11/03/2006] [Indexed: 01/06/2023]
Abstract
Several therapeutic agents have been investigated for the treatment of oral lichen planus (OLP). Among these are corticosteroids, retinoids, cyclosporine, and phototherapy, in addition to other treatment modalities. A systematic review of clinical trials showed that particularly topical corticosteroids are often effective in the management of symptomatic OLP lichen planus. Systemic corticosteroids should be only considered for severe widespread OLP and for lichen planus involving other mucocutaneous sites. Because of the ongoing controversy in the literature about the possible premalignant character of OLP, periodic follow-up is recommended. There is a spectrum of oral lichen planus-like ("lichenoid") lesions that may confuse the differential diagnosis. These include lichenoid contact lesions, lichenoid drug reactions and lichenoid lesions of graft-versus-host disease. In regard to the approach to oral lichenoid contact lesions the value of patch testing remains controversial. Confirmation of the diagnosis of an oral lichenoid drug reaction may be difficult, since empiric withdrawal of the suspected drug and/or its substitution by an alternative agent may be complicated. Oral lichenoid lesions of graft-versus-host disease (OLL-GVHD) are recognized to have an association with malignancy. Local therapy for these lesions rests in topical agents, predominantly corticosteroids.
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Affiliation(s)
- Ibtisam Al-Hashimi
- Salivary Dysfunction Clinic, Baylor College of Dentistry, Houston, TX, USA
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Scheer M, Kawari-Mahmoodi N, Neugebauer J, Kübler AC. Pimecrolimus (ELIDEL®) zur Behandlung des Lichen planus mucosae. ACTA ACUST UNITED AC 2006; 10:403-7. [PMID: 17051364 DOI: 10.1007/s10006-006-0030-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Oral lichen planus (OLP) is a common chronic inflammatory disorder with criteria of auto-reactive disease. Treatment consists on topical application of corticosteroids, vitamin A derivates or cyclosporin. Calcineurin inhibitors as tacrolimus and pimecrolimus decrease the production of cytokines and inhibit T-cell proliferation. These substances have recently been introduced for local therapy of chronic inflammatory skin disorders. The aim of our study was to evaluate the effectiveness and side effects of local pimecrolimus in OLP. A group of five patients with histological proven OLP were treated with topical pimecrolimus 1% ointment twice daily to the affected area. Prior to treatment and after 7, 14, 28 and 42 days the lesions were assessed clinically and by photographs. The discomfort scores were evaluated by visual analogue scale (VAS) weekly. All five patients (median age 65.6 years) were female and showed involvement of the buccal mucosa. All lesions showed a reduction of inflammation activity during the treating period. The VAS scores decreased significantly under treatment (p=0,0014). Pimecrolimus ointment was tolerated well with no signs of itching or burning. However, 4 out of 5 patients complained about the reduced adherence properties of the cream. Although no complete remission of OLP has been observed in our series, signs of inflammatory activity of OLP as redness and burning sensations were reduced by topical pimecrolimus. Further controlled randomized studies have to be conducted to compare topical pimecrolimus with topical corticosteroid as standard therapy. The adherence properties of pimecrolimus 1% cream should be improved for intra-oral application.
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Affiliation(s)
- M Scheer
- Klinik und Poliklinik für Zahnärztliche Chirurgie und für Mund-, Kiefer- und Plastische Gesichtschirurgie der Universität zu Köln, Kerpener Strasse 62, 50931 Köln, Germany.
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Belfiore P, Di Fede O, Cabibi D, Campisi G, Amarù GS, De Cantis S, Maresi E. Prevalence of vulval lichen planus in a cohort of women with oral lichen planus: an interdisciplinary study. Br J Dermatol 2006; 155:994-8. [PMID: 17034531 DOI: 10.1111/j.1365-2133.2006.07480.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Lichen planus (LP) is a mucocutaneous inflammatory dermatosis that frequently involves the oral and genital mucosae. Patients with LP affecting these sites are often seen by oral medicine specialists or gynaecologists who work in isolation and depend heavily on histopathologists to help them in confirming the diagnosis. There are few studies in the literature combining the experiences of these specialists who share the care of patients with both oral and genital LP. OBJECTIVES To estimate the prevalence of vulval LP (VLP) in a cohort of patients with histologically confirmed oral LP (OLP). METHODS The study group consisted of 42 women histologically diagnosed with OLP. The mean age was 60.5 years (range 27-81). They underwent genital examination, colposcopy and vulvoscopy. For the histological confirmation of clinical VLP biopsies were performed whenever a clinical lesion was found. Oral and genital biopsy specimens were processed through histological and immunohistochemical staining. Histological diagnoses of LP were made according to the modified World Health Organization histopathological criteria proposed by van der Meij and van der Waal for the diagnosis of OLP, and extended to VLP. Patients with clinical evidence, but without the histological confirmation of OLP and VLP, were excluded from the study group. RESULTS Thirty-two vulval and one vaginal biopsy specimens were obtained. Histological diagnoses were confirmed in 24 of 32 (75%) patients who underwent a vulval biopsy: these represent 57% (24 of 42) of the study group. Of the 12 patients free of symptoms such as itching, burning and dyspareunia, but with clinical vulval lesions, 11 (92%) had histological confirmation of VLP. Vulval lichen sclerosus was ascertained in five of 32 (16%) cases. CONCLUSIONS This study showed a 57% prevalence of VLP in selected patients with OLP. The high prevalence of VLP of 92% in the women who were free of vulval symptoms confirmed the usefulness of this careful integrated approach.
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Affiliation(s)
- P Belfiore
- Mother and Child Department, Gynaecology and Obstetrics Institute, Palermo, Italy.
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Becker JC, Houben R, Vetter CS, Bröcker EB. The carcinogenic potential of tacrolimus ointment beyond immune suppression: a hypothesis creating case report. BMC Cancer 2006; 6:7. [PMID: 16405733 PMCID: PMC1386691 DOI: 10.1186/1471-2407-6-7] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2005] [Accepted: 01/11/2006] [Indexed: 11/10/2022] Open
Abstract
Background Since tacrolimus ointment was approved by the U.S. Food and Drug Administration (FDA) as a promising treatment for atopic dermatitis, it has been approved in more than 30 additional countries, including numerous European Union member nations. Moreover, in the current clinical routine the use of this drug is no longer restricted to the approved indication, but has been extended to a wide variety of inflammatory skin diseases including some with the potential of malignant transformation. So far, the side-effects reported from the topical use of tacrolimus have been relatively minor (e.g. burning, pruritus, erythema). Recently, however, the FDA reviewed the safety of topical tacrolimus, which resulted in a warning that the use of calcineurin inhibitors may be associated with an increased risk of cancer. Case presentation Oral lichen planus (OLP) was diagnosed in a 56-year-old women in February 1999. After several ineffective local and systemic therapeutic measures an off-label treatment of this recalcitrant condition using Tacrolimus 0.1% ointment was initiated in May 2002. After a few weeks of treatment most of the lesions ameliorated, with the exception of the plaques on the sides of the tongue. Nevertheless, the patient became free of symptoms which, however, reoccurred once tacrolimus was weaned, as a consequence treatment was maintained. In April 2005, the plaques on the left side of the tongue appeared increasingly compact and a biopsy specimen confirmed the suspected diagnosis of an oral squamous cell carcinoma. Conclusion The suspected causal relationship between topical use of tacrolimus and the development of a squamous cell carcinoma prompted us to test the notion that the carcinogenicity of tacrolimus may go beyond mere immune suppression. To this end, tacrolimus has been shown to have an impact on cancer signalling pathways such as the MAPK and the p53 pathway. In the given case, we were able to demonstrate that these pathways had also been altered subsequent to tacrolimus therapy.
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Affiliation(s)
- Jürgen C Becker
- Department of Dermatology, Julius-Maximilians-University, Würzburg, Germany
| | - Roland Houben
- Department of Dermatology, Julius-Maximilians-University, Würzburg, Germany
| | - Claudia S Vetter
- Department of Dermatology, Julius-Maximilians-University, Würzburg, Germany
| | - Eva B Bröcker
- Department of Dermatology, Julius-Maximilians-University, Würzburg, Germany
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Aghahosseini F, Arbabi-Kalati F, Fashtami LA, Djavid GE, Fateh M, Beitollahi JM. Methylene blue-mediated photodynamic therapy: A possible alternative treatment for oral lichen planus. Lasers Surg Med 2006; 38:33-8. [PMID: 16392150 DOI: 10.1002/lsm.20278] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES In this study, methylene blue-mediated photodynamic therapy (MB-PDT) was used as a possible alternative method for the treatment of oral lichen planus (OLP). STUDY DESIGN/MATERIALS AND METHODS Thirteen patients with 26 OLP lesions were enrolled in this study. Patients were instructed to gargle a 5% methylene blue solution in water for 5 minutes. Ten minutes later, irradiation was performed by laser light (lambda = 632 nm, light exposure dose = 120 J/cm(2)). Lesions were evaluated pre and post-operatively and at follow-up sessions by changes in sign and symptom (pain) scores, and size of lesions. RESULTS Improvement in sign scores was achieved in 16 lesions. Four keratotic lesions disappeared completely. There was a statistically significant decrease in sign and symptom scores 1 week after treatment and at follow-up sessions up to 12 weeks. Average reduction in size of lesions was 44.3%. CONCLUSION MB-PDT seems to be an effective alternative treatment for control of OLP. In our opinion, this preliminary result warrant further studies in order to show the efficacy of MB-PDT in control of OLP for a longer period of time.
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Affiliation(s)
- Farzane Aghahosseini
- Oral Medicine Department, Faculty of Dentistry, Tehran University of Medical Sciences, TUMS, Tehran, Iran
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DeRossi SS, Ciarrocca KN. Lichen planus, lichenoid drug reactions, and lichenoid mucositis. Dent Clin North Am 2005; 49:77-89, viii. [PMID: 15567362 DOI: 10.1016/j.cden.2004.08.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Lichen planus is a common mucocutaneous disease affecting a significant portion of the general population. This article reviews the most current concepts on the epidemiology, etiology, pathogenesis, clinical presentations, and treatment of oral lichen planus, lichenoid drug reactions, and lichenoid mucositis.
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Affiliation(s)
- Scott S DeRossi
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104, USA.
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Affiliation(s)
- Anne Krantz
- Section of Clinical Toxicology, John H. Stroger, Jr. Hospital of Cook County, University of Illinois at Chicago School of Public Health, USA
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